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肝外胆道囊腺癌罕见,较位于肝内者更为少见.Mayo临床中心曾收治7例,患者平均年龄为47岁(20～67岁),均为女性.肿瘤位于胆总管4例,其中并侵及左、右肝管各2例,位于左肝管2例和胆囊管1例.l例仅行胆囊切除,余6例均切除肿瘤和行肝管空肠吻合术.1例手术后死于脓毒症;1例于术后4月复发,再行切除,已生存15年;余4年已分别随访8月、8年、10年和33年,均无复发.其主要症状分别为黄疸和右上腹痛各4例次、血叫症1例.胆道造影对诊断最有帮助.作者还复习了文献上报道的19例肝胆道囊腺瘤病例,其发生率约占0.1%胆道手术病例,或占6%全部肝外胆道肿瘤.肝外囊状胆道病变为先天性胆道扩张,按Geist分析,囊腺瘤约占4.6%全部肝智囊性病变,多数位于肝内,仅10%位于肝外胆管.Burhans统计84例肝外良性地道肿瘤,计乳头状瘤41例、腺瘤39例、颗粒细胞成肌细胞瘤4例和纤维瘤、神经瘤、平滑肌瘤及错构瘤各1例.肝外胆管腺瘤可分为实质性、囊性和混合性,囊腺瘤较不多见.囊腺瘤的主要症状为黄疸(85%),并有不同程度的郁胆症.其他症状有腹痛(50%)、发热(7.7%)和血胆症(7.7%).可均匀分布于胆总管和左、右肝管,胆囊管少见.局部切除者半数可复发,平均在术后13个月(4～24个月).鉴于囊腺瘤可能是癌前期病变,应作胆管节段性切除,切缘要阴性,并作肝
Extrahepatic biliary cystadenocarcinoma is rare and rarer than that in the liver. Mayo clinical center has been treated in 7 cases. The average age of the patients is 47 years old (20-67 years old) and all of them are females. The tumors are located in the common bile duct in 4 cases. Invading the left and right hepatic ducts in 2 cases, located in the left hepatic duct in 2 cases and 1 case of cystic duct. 1 cases only cholecystectomy, the remaining 6 cases were all tumor resection and hepaticojejunostomy. 1 case died after surgery In sepsis, 1 patient relapsed at 4 months after operation, re-excised, and had survived for 15 years; the remaining 4 years had been followed up for 8 months, 8 years, 10 years, and 33 years, with no recurrence. The main symptoms were: There were 4 cases of jaundice and 4 cases of right upper abdominal pain and 1 case of hemorrhage. Cholangiography was the most helpful to the diagnosis. The author also reviewed 19 cases of hepatobiliary cystadenoma reported in the literature. The incidence rate was about 0.1%. , or 6% of all extrahepatic biliary tract tumors. Extrahepatic cystic biliary lesions are congenital biliary dilation, according to Geist analysis, cystic adenomas account for about 4.6% of all hepatic brain cystic lesions, most located in the liver, only 10% in the liver Outer bile ducts. Burhans statistics 84 cases of extrahepatic benign tumors, including 41 cases of papilloma, adenoma in 39 cases, 4 cases of granulocyte myoblastoma and fibroids, neuroma, smoothing 1 case of fibroids and hamartoma. Extrahepatic bile duct adenomas can be divided into substantial, cystic and mixed, cystic adenomas are rarer. The main symptom of cystadenoma is jaundice (85%), and there are Different degrees of gall bladder disease. Other symptoms are abdominal pain (50%), fever (7.7%) and blood gallbladder disease (7.7%). Can be evenly distributed in the common bile duct and left and right hepatic ducts, cystic duct rare. Local resection Half of the patients can relapse, with an average of 13 months (4 to 24 months). Since cystic adenomas may be precancerous lesions, they should be treated with segmental biliary tractectomy, with negative margins and liver function.