膽管內乳頭狀腫瘤末期西醫放棄而中醫接手治療成功的病例分享

這是一個59歲中年婦女，常年有貝西氏症，服用免疫藥物加上體質特殊，血液檢驗數據及生化指數都正常，但因為肝腎上都長滿水泡，水泡遮蔽故影像檢查並無法發現其異常。醫生雖然懷疑肝內膽管癌，但因切片檢查未切到癌細胞，一直到腫瘤破裂，腹痛甚送醫急診，開刀才發現膽管導管內乳頭狀腫瘤（Intraductal papillary neoplasm of the bile duct, IPNB），檢查為惡性。膽管導管管內型乳頭狀腫瘤在臨床上非常罕見，術前也不易診斷，而存活率也非常低，多發性、多灶性且復發率高，病因尚不清楚。該病例的治療除了97/11/15手術外，因為化療效果差，故醫師不建議做，主刀醫師明白告知可能活不到三個月，該醫學中心歷年來統計與之相同病例已逝49位，她係第50位。此病例口服藥物只有urso（Ursodeoxycholic Acid）利膽能錠外，幾乎沒有什麼治療方法。當時由中央研究院分子生物研究所所長沈院士介紹來診。此一病例是李政育中醫師單純用中醫治療，照顧了8年多，改善患者日常的生活品質，我將其大部分及重要過程病歷一一的呈現出來。

關鍵字

膽管導管內乳頭狀腫瘤；膽管內乳頭狀腫瘤；膽道乳頭狀瘤病；粘液性膽管癌；膽管癌

並列摘要

This is a 59-year-old middle-aged woman who has been suffering from Behcet's disease all year round. She takes immune drugs and has a special constitution. Her blood test data and biochemical index are normal. However, because her liver and kidneys are covered with blisters, the blisters cover her body, so imaging cannot be done. Found its anomaly. Although the doctor suspected intrahepatic cholangiocarcinoma, no cancer cells were found in the biopsy. It was not until the tumor ruptured and he was sent to the emergency room for abdominal pain that he found intraductal papillary neoplasm of the bile duct (IPNB) during surgery. The test was malignant. Intraductal papillary neoplasms of the bile duct are very rare clinically and are not easy to diagnose before surgery. The survival rate is also very low. They are multiple, multifocal and have a high recurrence rate. The cause is still unclear. In addition to surgery on November 15, 2008, the treatment for this case was not recommended because of poor chemotherapy effects. The surgeon in charge clearly informed that he might not live for three months. The medical center has counted 49 patients with the same case over the years. , she is ranked 50th. In this case, the only oral medication available was urso (Ursodeoxycholic Acid) choleretic tablets, and there were almost no treatments. At that time, Academician Shen, director of the Institute of Molecular Biology, Academia Sinica, introduced him to the hospital for treatment. This case was treated by Dr. Lee Chen-Yu using only TCM. He took care of it for more than 8 years and improved the patient's daily quality of life. I will present most of the patient's medical records and the important process one by one.

並列關鍵字

Intraductal Papillary Neoplasm of the Bile Duct ； IPNB ； Bile Duct Papillary Tumor Disease ； Mucinous Biliary Tract Cancer ； Cholangiocarcinoma

參考文獻

Ohtsuka M, Shimizu H, Kato A, Yoshitomi H, Furukawa K, Tsuyuguchi T, Sakai Y, Yokosuka O, Miyazaki M. Intraductal papillary neoplasms of the bile duct. Int J Hepatol. 2014; 2014:459091. doi: 10.1155/2014/459091. Epub 2014 May 18. PMID: 24949206; PMCID: PMC4052179.

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Yeung YP, AhChong K, Chung CK, Chun AY. Biliary papillomatosis: report of seven cases and review of English literature. J Hepatobiliary Pancreat Surg. 2003; 10(5):390-5. doi: 10.1007/s00534-002-0837-0. PMID: 14598142.

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