PDF(Pubmed)
Abstract：
BACKGROUND: Biliary obstruction due to compression by a B-cell solid tumor occurs rarely. A few reports have described biliary reconstruction surgery for obstructive jaundice caused by Burkitt\'s lymphoma. However, there are no detailed reports on pediatric cases. We report a pediatric case of obstructive jaundice due to malignant lymphoma treated with biliary reconstruction surgery.
METHODS: A 5-year-old girl presented to our hospital with a massive abdominal tumor that caused biliary stricture. Chemotherapy was initiated after an open tumor biopsy. However, endoscopic biliary stent placement was performed owing to elevated bilirubin levels. We treated the patient with chemotherapy for 9 months while endoscopically replacing the biliary stent every few months. She achieved complete tumor remission. However, sclerotic lymph nodes were persistent on the dorsal side of the cholecystic duct junction, and biliary stricture at the same site had changed to stent-dependent biliary obstruction. Therefore, we performed choledochojejunostomy and retrocolic Roux-en-Y reconstruction 15 months after initial admission. There were no postoperative complications or tumor recurrences, and the bilirubin level remained low. Histopathologically, the resected bile duct wall was fibrotic and thick, and the bile duct lumen narrowed.
CONCLUSIONS: Biliary reconstruction is effective to achieve long-term biliary patency in pediatric patients with stent-dependent biliary obstruction due to malignant lymphoma. However, the decision on when to stop biliary stent replacement and proceed to biliary reconstruction surgery is a matter of debate. Further case studies are required to address this issue.
METHODS: A 5-year-old girl presented to our hospital with a massive abdominal tumor that caused biliary stricture. Chemotherapy was initiated after an open tumor biopsy. However, endoscopic biliary stent placement was performed owing to elevated bilirubin levels. We treated the patient with chemotherapy for 9 months while endoscopically replacing the biliary stent every few months. She achieved complete tumor remission. However, sclerotic lymph nodes were persistent on the dorsal side of the cholecystic duct junction, and biliary stricture at the same site had changed to stent-dependent biliary obstruction. Therefore, we performed choledochojejunostomy and retrocolic Roux-en-Y reconstruction 15 months after initial admission. There were no postoperative complications or tumor recurrences, and the bilirubin level remained low. Histopathologically, the resected bile duct wall was fibrotic and thick, and the bile duct lumen narrowed.
CONCLUSIONS: Biliary reconstruction is effective to achieve long-term biliary patency in pediatric patients with stent-dependent biliary obstruction due to malignant lymphoma. However, the decision on when to stop biliary stent replacement and proceed to biliary reconstruction surgery is a matter of debate. Further case studies are required to address this issue.
摘要：
背景：由于B细胞实体瘤压迫引起的胆道阻塞很少发生。一些报道描述了由Burkitt淋巴瘤引起的梗阻性黄疸的胆道重建手术。然而,没有关于儿科病例的详细报告。我们报告了一例因恶性淋巴瘤而接受胆道重建手术治疗的儿童阻塞性黄疸病例。
方法：一名5岁女孩因腹部巨大肿瘤导致胆道狭窄来到我院。开放肿瘤活检后开始化疗。然而,由于胆红素水平升高,行内镜下胆道支架置入术.我们对患者进行了9个月的化疗，同时每隔几个月进行一次内镜下更换胆道支架。她实现了肿瘤完全缓解。然而,硬化淋巴结持续存在于胆囊管交界处的背侧，并且同一部位的胆道狭窄已转变为支架依赖性胆道梗阻。因此,首次入院后15个月,我们进行了胆总管空肠吻合术和后绞痛Roux-en-Y重建术.术后无并发症及肿瘤复发,胆红素水平仍然很低。组织病理学,切除的胆管壁纤维化且厚，胆管管腔变窄了.
结论：胆道重建对于恶性淋巴瘤引起的支架依赖性胆道梗阻的儿科患者实现长期胆道通畅是有效的。然而,关于何时停止胆道支架置换术并进行胆道重建手术的决定是一个有争议的问题。需要进一步的案例研究来解决这个问题。
方法：一名5岁女孩因腹部巨大肿瘤导致胆道狭窄来到我院。开放肿瘤活检后开始化疗。然而,由于胆红素水平升高,行内镜下胆道支架置入术.我们对患者进行了9个月的化疗，同时每隔几个月进行一次内镜下更换胆道支架。她实现了肿瘤完全缓解。然而,硬化淋巴结持续存在于胆囊管交界处的背侧，并且同一部位的胆道狭窄已转变为支架依赖性胆道梗阻。因此,首次入院后15个月,我们进行了胆总管空肠吻合术和后绞痛Roux-en-Y重建术.术后无并发症及肿瘤复发,胆红素水平仍然很低。组织病理学,切除的胆管壁纤维化且厚，胆管管腔变窄了.
结论：胆道重建对于恶性淋巴瘤引起的支架依赖性胆道梗阻的儿科患者实现长期胆道通畅是有效的。然而,关于何时停止胆道支架置换术并进行胆道重建手术的决定是一个有争议的问题。需要进一步的案例研究来解决这个问题。
