하부담관암의 임상적 고찰

Abstract

Primary cancer of the extrahepatic bile duct is classified according to its anatomical location as upper, middle, and distal. In general, among them distal bile duct cancer has the best prognosis due to the highest resectability rate. Yet, the only lesion that is expected to be cured is limited to the early bile duct cancer. Therefore, earlier recognition and treatment with resection will be necessary to increase survival rates. A retrospective analysis was conducted in 17 patients with distal bile duct cancer managed at our hospital during 2 year-period(1989. 6∼1991. 5).

The results were follows ;

1) The incidence of the distral bile duct cancer among the extrahepatic bile duct cancers and among the periampullary cancers was 44.7% and 37.0%, respectively.

2) The most common age group was in the 7th decade and male to female ratio was 3.25 : 1.

3) The most common clinical manifestation was jaundice and there were 5 patients who showed the symptoms and signs of acute cholangitis.

4) Among the laboratory findings, almost all patients showed abnormal liver function, especially in SGOT, SGPT, alkaline phophatase, and total bilirubin.

5) By the use of diagnostic tools, the preoperative diagnosis were made in 15 patients (88.2%).

6) As for the operative treatment, we performed Whipple procedure in 13 and total pancreatectomy in 1 with 82.4% of the resectability rate.

7) Histopathologically, most of the lesions were infiltrative type(88.2%) and diagnosed as adenocarcinoma(93.8%).

8) According to the TNM staging, AJCC, 1988, stage Ⅳ lesions were most common(47.0%).

9) There were 2 cases of postoperative death(mortality rate : 11.8%), one was following Whipple procedure-stage ⅣA and the other following biopsy only-stage ⅣB. Accordingly, operative mortality after resection was 7.1% and 33.3% in non-resected group.

10) In our cases, the long-term results. Nevertheless, there were 4 cases of death with their mean survival time of 11.4 months(stage Ⅲ-14 months, stage ⅣA-8.8 months).

Primary cancer of the extrahepatic bile duct is classified according to its anatomical location as upper, middle, and distal. In general, among them distal bile duct cancer has the best prognosis due to the highest resectability rate. Yet, the only lesion that is expected to be cured is limited to the early bile duct cancer. Therefore, earlier recognition and treatment with resection will be necessary to increase survival rates. A retrospective analysis was conducted in 17 patients with distal bile duct cancer managed at our hospital during 2 year-period(1989. 6∼1991. 5).

The results were follows ;

1) The incidence of the distral bile duct cancer among the extrahepatic bile duct cancers and among the periampullary cancers was 44.7% and 37.0%, respectively.

2) The most common age group was in the 7th decade and male to female ratio was 3.25 : 1.

3) The most common clinical manifestation was jaundice and there were 5 patients who showed the symptoms and signs of acute cholangitis.

4) Among the laboratory findings, almost all patients showed abnormal liver function, especially in SGOT, SGPT, alkaline phophatase, and total bilirubin.

5) By the use of diagnostic tools, the preoperative diagnosis were made in 15 patients (88.2%).

6) As for the operative treatment, we performed Whipple procedure in 13 and total pancreatectomy in 1 with 82.4% of the resectability rate.

7) Histopathologically, most of the lesions were infiltrative type(88.2%) and diagnosed as adenocarcinoma(93.8%).

8) According to the TNM staging, AJCC, 1988, stage Ⅳ lesions were most common(47.0%).

9) There were 2 cases of postoperative death(mortality rate : 11.8%), one was following Whipple procedure-stage ⅣA and the other following biopsy only-stage ⅣB. Accordingly, operative mortality after resection was 7.1% and 33.3% in non-resected group.

10) In our cases, the long-term results. Nevertheless, there were 4 cases of death with their mean survival time of 11.4 months(stage Ⅲ-14 months, stage ⅣA-8.8 months).