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21.
Tsuyoshi Igami Yukihiro Yokoyama Hideki Nishio Tomoki Ebata Yoshie Shimoyama Shigeo Nakamura Masato Nagino 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(4):579-584
We report a case of small pancreatic carcinoma misdiagnosed as superficially spreading cholangiocarcinoma using percutaneous
transhepatic cholangioscopy (PTCS). The patient was a 72-year-old man admitted to a local hospital with obstructive jaundice.
The patient underwent percutaneous transhepatic biliary drainage and PTCS. He was referred to our hospital with a diagnosis
of superficially spreading cholangiocarcinoma. Cholangiography revealed a stenosis of the common bile duct, and also revealed
some irregularities from the common hepatic duct to the left hepatic duct, suggesting a superficial spread of cancer. No pancreatic
tumor was identified by endoscopic retrograde pancreatography or by enhanced computed tomography. Cholangioscopy disclosed
an elevated tumor with torsional vessels and granular mucosal lesions, which were extended to the left hepatic duct. Repeated
cholangioscopic biopsies of the bile duct mucosa revealed adenocarcinoma. The patient was diagnosed with superficially spreading
cholangiocarcinoma extending to the left hepatic duct and the right anterior hepatic duct. Left trisectionectomy combined
with pancreatoduodenectomy was performed. The cut surface of the resected specimen showed a pancreatic head tumor that was
8 mm in diameter. Histological findings of the resected specimen revealed adenocarcinoma arising from the pancreatic head
with invasion in the common bile duct. Additionally, extensive inflammatory granulation tissue was observed along the surface
of the bile duct, without any evidence of carcinoma. This case implies to us that the results of PTCS, even after repeated
biopsies, should be interpreted with great caution. 相似文献
22.
Takada T 《Journal of Hepato-Biliary-Pancreatic Surgery》2001,8(1):58-64
Preoperative biliary drainage has been in use for a long time and is still being performed today in some institutions, but
there has been a long-standing issue as to whether the necessity of this procedure has been proven medically. Many problems
existed previously, such as systemic complications due to the difficulty in diagnosing and differentiating obstructive jaundice
from jaundice left untreated for a long time, or surgeon-based problems such as a lack of surgical skill or undeveloped surgical
techniques, or even inexperience in perioperative patient management. These problems, however, are being overcome with time,
and the advantages of preoperative biliary drainage are now being questioned according to evidence-based medicine. Several
recent controlled trials have clearly shown that preoperative biliary drainage is not necessary for lower bile duct obstruction,
although it was noted that surgery after reduction of jaundice by percutaneous transhepatic cholangial drainage (PTCD) was
very easily performed. It is important to understand that preoperative biliary drainage is unnecessary for lower bile duct
obstruction, whether the technique follows a percutaneous approach, an endoscopic apporach, or stenting. Although it is still
being debated, there have already been several reports regarding whether preoperative biliary drainage is necessary for upper
bile duct obstruction, such as hilar bile duct carcinoma. This also needs to be clarified by randomized controlled trials.
Aside from preoperative biliary drainage, the utilization of biliary drainage or stenting has been fully recognized as important
for removing intrahepatic stones or choledochal stones, as well as for emergency drainage for acute cholangitis and for the
treatment of unresectable malignant biliary stenosis. Additionally, percutaneous transhepatic cholangioscopy (PTCS), using
the PTCD, or percutaneous transhepatic biliary drainage (PTBD) route, plays a major role not only in the removal of biliary
stones but also in the diagnosis of cases in which it is difficult to differentiate between benign and malignant lesions.
Received: August 2, 2000 / Accepted: September 22, 2000 相似文献
23.
目的 探讨经皮经肝胆道镜(PTCS)治疗肝内胆管结石的临床应用价值.方法 回顾性分析70例进行PTCS手术的肝内胆管结石患者,评价患者术后结石清除情况以及在接受PTCS手术后随访评价结石复发情况.结果 肝内胆管结石患者的彻底清除60例,术后清除率为85.7%.61例患者的平均随访时间为6年,经影像学检查证实有12例结石复发.结论 PTCS对治疗肝内胆管结石是一种安全、有效、易重复的方法,具有取石快、结石残留率低、术后并发症少、微创等优点.PTCS是原发性胆管结石中具有较大临床应用价值. 相似文献
24.