先天性胆总管囊肿癌变危险因素及预后分析

doi:10.7504/nk2014110502

摘要/Abstract

摘要：

目的探讨先天性胆总管囊肿(congenital choledochal cysts，CCC)患者癌变危险因素及预后。方法回顾性分析2002年2月至2014年4月温州医科大学附属第一医院收治的115例CCC患者，按照癌变的发生与否，将病例分癌变组(A组)和非癌变组(B组)，通过单因素及多因素Logitic回归分析与囊肿癌变有关的危险因素，同时对A组进行生存分析。结果 115例CCC患者癌变12例，癌变率10.4％。单因素分析结果得出：年龄增加、病程长、合并黄疸、合并胆石症、肝功能异常［包括结合胆红素(CB)、碱性磷酸酶(ALP)、γ谷氨肽转肽酶(γ-GT)的升高］与CCC癌变具有相关性(P<0.05)。多因素Logitic回归分析显示，年龄增长、病程长、CB升高是CCC癌变发生的独立危险因素(P<0.05)。A组患者术后生存1～72个月，生存期(28.1±8.8)个月(95%CI 10.817～45.461)。结论 CCC是一种癌前病变，年龄增长、病程长、CB升高是CCC癌变的危险因素。CCC癌变患者预后不佳，确诊CCC患者，应尽早行囊肿切除、肝管空肠吻合术，防止癌变。

关键词: 先天性胆总管囊肿, 癌变, 危险因素, 预后

Abstract:

Abstract：Objective To identify the potential risk factors involved in congenital choledochal cysts(CCC) malignancy transformation，as well as to elucidate survival statue in subsequent maligancy.Methods A total number of 115 patients that diagnosed as CCC in the first affiliated Hospital of Wenzhou Medical University from February 2002 to April 2014 were retrospectively reviewed，which were divided into two groups，with malignancy(A group) and without malignancy(B group).Univariate and multivariate Logistic analysis were conducted to evaluate risk factors associated with incidence of malignant change，while to survival analysis of A group.Results Among 115 cases of patientsthat diagnosed as CCC，12 cases were arising with malignancy，the total malignancy rate was 10.4%.In univariate analysis，significant differences were found between these two groups by increased of age and disease duration；Combined with jaundice and biliary calculi；and liver disfuntion (increased of CB，ALP，γ-GT)(P<0.05).In logistic regression analysis，only increated of age.disease duration and CB were recognized as the significative factors(P<0.05).In A group，the surviving time was 1 to 72months，and the middle survival time was (28.1±8.8)months(95%CI 10.817-45.461).Conclusion CCC is a premalignant lesion，incerated of age.disease duration and CB is related risk factors.the prognosis of CCC with malignancy is poor，total cysts excision and hepaticojejunostomy is an effective treatment for patients diagnosed as CCC in order to reduce the chance of subsequent development of maligancy.

Key words: congenital choledochal cysts, malignant change, risk factors, prognosis

中图分类号:

R575.7

管华琴a，陈仁聘a，金思思a，陈超a，张纯武b，吴建胜a. 先天性胆总管囊肿癌变危险因素及预后分析[J]. 中国实用内科杂志, DOI: 10.7504/nk2014110502.

GUAN Hua-qin，CHEN Ren-pin，JIN Si-si，CHEN Chao,ZHANG Chun-wu,WU Jian-sheng. Related risk factors and prognostic evaluation of malignant change followed by congenital choledochal cysts[J]. Acta Metallurgica Sinica, DOI: 10.7504/nk2014110502.

参考文献



[1］Wang B，Feng Q，Mao JX，et al.Early experience with laparoscopic excision of choledochal cyst in 41 children［J］.J Pediatr Surg，2012，47(12)：2175-2178. 

[2］Walker SK，Maki AC，Cannon RM，et al.Etiology and incidence of pediatric gallbladder disease［J］.Surgery，2013，154(4)：927-931. 

[3］Irwin ST.Morsion TE.Congenital cyst of the common bile duct containing stones and andering cancerous charge［J］.Br J Surg，1944，32：319-321. 

[4］Tabatabaie P，Fallahi GH，Farahmand F，et al.Congenital choledochal cyst in an infant with cystic fibrosis［J］.Ann Hepato，2009，8(2)：156-157. 

[5］Wang JT，Wu N.Type IV congenital choledochal cyst concurrent with acute pancreatitis：a case report ［J］.Hepatobiliary Pancreat Dis Int,2005，4(2)：311-312. 

[6］Voyles CR，Smadja C，Shands WC，et al.Carcinoma in choledochal cysts.Age-related incidence［J］.Arch Surg，1983，118(8)：986-986. 

[7］Dumitrascu T，Lupescu I，Ionescu M.The Todani classification for bile duct cysts：an overview［J］.Acta Chir Belg，2012，112(5)：340-345. 

[8］Jablonska B.Biliary cysts：etiology，diagnosis and management［J］.World J Gastroenterol，2012，18(35)：4801-4810. 

[9］Kamisawa T，Okamoto A，Tsuruta K，et al.Carcinoma arising in congenital choledochal cysts［J］.Hepatogastroenterology，2008，55(82-83)：329-332. 

[10］Benjamin IS.Biliary cystic disease：the risk of cancer［J］.J Hepatobiliary Pancreat Surg，2003，10(5)：335-339. 

[11］冯继峰，陈文有，陈达丰，等.胆总管囊肿癌变的临床特点及预后分析［J］.肝胆外科杂志，2010，18(5)：347-350. 

[12］魏蓉娜，曹泽伟.成人先天性胆管扩张症68例临床研究［J］.中华消化杂志，2011，31(2)：82-85. 

[13］Lee KF，Lai ECH，Lai PBS.Adult choledochal cyst［J］.Asian J Surg，2005，28(1)：29-33. 

[14］Dumitrascu T，Ionescu M.An unclassified congenital bile duct cyst［J］.Acta Chir Belg，2014，114(1)：82-83. 

[15］McLean MH，Murray GI，Fyfe N，et al.COX-2 expression in sporadic colorectal adenomatous polyps is linked to adenoma characteristics［J］.Histopathology，2008，52(7)：806-815. 

[16］百强，张小文，董克刚.凋亡抑制蛋白基因在先天性胆总管囊肿和胆管癌中的表达及意义［J］.中华肝胆外科杂志，2012，18(4)：266-269. 

[17］Watanabe Y，Toki A，Todani T.Bile duct cancer developed after cyst excision for choledochal cyst［J］.J Hepatobiliary Pancreat Surg，1999，6(3)：207-212. 

[18］刘源，刘冰阳，周勇，等.先天性胆总管囊肿术后远期并发症及处理［J］.中国实用外科杂志，2011，31(1)：86-88. 

[19］Ohashi T，Wakai T，Kubota M，et al.Risk of subsequent biliary malignancy in patients undergoing cyst excision for congenital choledochal cysts［J］.J Gastroenterol Hepatol，2013，28(2)：243-247. 

[20］Lee SE，Jang JY.Development of biliary malignancy after cyst excision for congenital choledochal cysts：What should we do?［J］.J Gastroenterol Hepatol，2013，28(2)：210-212. 

[1]	王娜, 季颖群. 《中国肺动脉高压诊断与治疗指南（2021版）》解读——动脉性肺动脉高压的危险分层[J]. 中国实用内科杂志, 2021, 41(9): 789-793.
[2]	刘蕾，马壮. 急性肺血栓栓塞症的危险因素及诊断策略[J]. 中国实用内科杂志, 2021, 41(6): 490-492.
[3]	徐若豪1，2，杜欣1，. 慢性粒单核细胞白血病预后系统的循证评价[J]. 中国实用内科杂志, 2021, 41(4): 296-300.
[4]	张朝阳, 蔡广研. 老年血液透析患者预后影响因素研究进展 [J]. 中国实用内科杂志, 2021, 41(11): 913-916.
[5]	宋陆茜, 常春康. 基因特征研究在骨髓增生异常综合征诊疗中的进展 [J]. 中国实用内科杂志, 2021, 41(10): 832-835.
[6]	陈吉林, 林洪丽. 血液透析时机的选择 [J]. 中国实用内科杂志, 2021, 41(10): 839-844.
[7]	周炯涛，何广胜. SF3B1 突变型骨髓增生异常综合征亚型发病机制及诊断[J]. 中国实用内科杂志, 2021, 41(1): 27-29.
[8]	李昱瑛，杨岩. 原发性骨髓纤维化的诊治进展[J]. 中国实用内科杂志, 2020, 40(9): 732-737.
[9]	杨琼琼. IgA肾病诊治相关的生物标志物[J]. 中国实用内科杂志, 2020, 40(7): 533-538.
[10]	常园园，段姝伟，蔡广研. IgA肾病病理评估的新认识[J]. 中国实用内科杂志, 2020, 40(7): 546-550.
[11]	陈勃江，李为民. 肺癌与呼吸系统合并症[J]. 中国实用内科杂志, 2019, 39(5): 399-402.
[12]	赵春光，张丽娜. 重症神经患者持续脑电监测应用现状[J]. 中国实用内科杂志, 2019, 39(12): 1020-1025.
[13]	李湘民. 心脏骤停自主循环恢复预后评估[J]. 中国实用内科杂志, 2019, 39(10): 858-861.
[14]	张圣1，楼敏2. 多模式影像评估指导静脉溶栓的研究进展[J]. 中国实用内科杂志, 2018, 38(8): 699-703.
[15]	段明辉. 原发性血小板增多症诊治进展[J]. 中国实用内科杂志, 2018, 38(2): 98-103.