Objective To evaluate the down stream involvement of the bile duct in hepatolithiasis.Methods Mechanical damage to bile duct epithelia and long standing cholangitis as result of hepatolithiasis play an important role in the carcinogenesis of bile duct epithelia and stricture of the intra- and extra-hepatic bile duct. Macromorphological and microscopic changes in bile duct mucosa of 100 consecutive patients with hepatolithiasis were investigated using intra- or post-operative cholangioscopy. Biopsy specimens of lesions obtained during cholangioscopy were studied with immunohistochemical staining and flow cytometry to determine proliferative activity and DNA content. Five cases of well-proven cholangiocarcinoma were simultaneously studied as controls.Results Of the 100 patients, those with chronic cholangitis accounted for 86% (86/100), proliferative lesions 11% (11/100), adenomatous polyps 1% (1/100), and adenocarcinoma 2% (2/100). The obvious mucosal lesion associated with hepatolithiasis was located down-stream of the bile duct, predominantly in the hilar region, e.g. orifices of the right/left hepatic duct and common hepatic duct (73% mucosa lesions in the hilar region). The intensity of cancer embryonic antigen stain and the proliferative cell nuclear antigen index increased with the development of bile duct lesions. Aneuploid DNA presented mainly in the high degree malignant adenocarcinomas (>80% of cases).Conclusions The obvious mucosal lesions associated with hepatolithiasis were located down-stream of the bile duct, predominantly in the hilar region (73% of mucosal lesions). The proliferative activity of examined bile duct mucosa lesions increased with the development of pathological deterioration, which may contribute to the development of hilar bile duct stricture and hilar cholangiocarcinoma.Department of Surgery (Lu SC, Yan LN, Rao LQ, Xia T and Gou JL), Department of Pathology (Zhang SY), Biotherapy Center of Oncological Department (Lei S), West China Hospital, Sichuan University, Chengdu 610041, China

肝门部胆管癌的诊治进展

肝门部胆管癌(hilar cholangiocarcinoma)是指发生在左肝管、右肝管、左右肝管分叉部和肝总管上段的癌.Klaskin于1965年详细地描述了此类肿瘤的临床特征,故常称为Klaskin 瘤.据报道,Klaskin瘤约占肝外胆管癌的58%～75%[1].由于以往对该病认识不足,加之肿瘤生长部位隐蔽,早期诊断较困难.患者多以进行性黄疸为主要表现,常被误诊为"传染性肝炎"而予以治疗,乃至患者到外科就诊时已为晚期.自20世纪80年代以来,随着现代影像技术的发展,临床上对肝门部胆管癌的诊断与治疗也取得了长足的进展.