总结术中意外发现肝外胆管绒毛管状腺瘤（EHBVTA）的诊治经验。

回顾性分析2021年4月至2022年4月解放军总医院肝胆胰外科医学部派驻第七中心收治的2例EHBVTA患者临床资料。例1男，66岁；例2女，59岁。临床症状均为间断发作上腹部疼痛，实验室检测结果均无明显异常。例1术前影像学检查示：胆囊结石，胆总管结石，肝内外胆管扩张伴管壁增厚。例2术前影像学检查示：低位胆道梗阻，胆总管下端类圆形充盈缺损，考虑胆总管结石、胆囊结石。

例1行腹腔镜胆囊切除、胆道探查取石术，术中发现"胆管腺瘤（中上段）"，一期实施肝外胆管切除、胆肠吻合术。例2行腹腔镜胆囊切除、胆道探查取石术，术中发现"胆管腺瘤（下端）"，放置T管引流，4周后再次行胰十二指肠切除术。2例患者术后病理均为"胆管绒毛管状腺瘤"，其中例1病灶局部呈高级别上皮内肿瘤伴癌变。2例患者随访至投稿日期未见复发。

EHBVTA发病率低，术前诊断困难，提高诊断率、根治性切除是获得良好预后的关键。

To summarize the diagnosis and treatment experience of extrahepatic bile villous tubular adenoma (EHBVTA) unexpectedly found during operation.

Clinical data of 2 patients with EHBVTA admitted to Department of Hepatobiliary and Pancreatic Surgery of Chinese PLA General Hospital residing in the Seventh Medical Center from April 2021 to April 2022 were retrospectively analyzed. The case 1 was male, aged 66 years, and the case 2 was female, aged 59 years. Clinical symptoms were intermittent epigastric pain, and no evident abnormality was found by laboratory testing. Preoperative imaging examination of case 1 showed gallbladder stones, common bile duct stones, dilatation of intra- and extra-hepatic bile ducts complicated with wall thickening. Preoperative imaging examination of case 2 detected low bile duct obstruction and circular filling defect at the lower end of common bile duct, which were considered as common bile duct stones and gallbladder stones.

In case 1, laparoscopic cholecystectomy and choledocholithotomy were performed, and "bile duct adenoma (middle and upper segments)" was found intraoperatively. Extrahepatic bile duct resection and cholangioenterostomy were performed during the first stage. Case 2 underwent laparoscopic cholecystectomy and bile duct exploration, and "bile duct adenoma (lower segment)" was observed during the operation. T tube was placed for drainage, and pancreaticoduodenectomy was repeatedly performed after 4 weeks. Postoperatively, both two patients were pathologically diagnosed with "EHBVTA". Case 1 developed high-grade intraepithelial tumor with canceration. No recurrence was observed in two patients upon the date of manuscript submission.

The incidence of EHBVTA is low, and preoperative diagnosis is challenging. Enhancing the diagnostic rate and radical resection play a critical role in obtaining favorable prognosis.