摘要
目的探讨肝内胆管结石与肝胆管癌发生的关系及提高早期诊断的措施。方法回顾性分析近2 0年收治的2 4例肝内胆管结石并发肝胆管癌患者的临床资料。结果肝内胆管结石并肝内胆管肿瘤在所有肝内胆管结石的病例中占2.8%(2 4/8 6 0),癌肿均发生于含结石胆管处,部分切片中可见癌与不同程度的胆管上皮不典型增生同时存在。术前B超、CT和MR I/MPCP对肝内胆管结石并发肝占位病变诊断率分别为4 0.9%(9/2 2),5 3.8%(7/1 3)和6 6.7%(4/6);手术切除率70.8%(1 7/2 4),根治性切除率为3 3.3%(8/2 4)例,姑息切除率为3 7.5%(9/2 4)。术后1,3年生存率:根治组为6 2.5%,2 5.0%,姑息性组为3 3.3%,1 1.1%,活检组为0%。结论长期肝内胆管结石反复发作是引起胆管癌发生的重要原因;结石型肝内胆管癌的延误诊断率高、根治性切除率低、预后差。重视结石型肝胆管癌临床延误诊断的原因并采取相应的避免措施有助于早期诊断。
Objective To explore the relationship of hepatocholangiocarcinoma and hepatolithiasis and to increase the early diagnosis of this disease. Methods The clinical data of 24 cases of hepatocholangiocacinoma associated with hepatolithiasis were retrospectively analyzed. Results The occurrence rate of hepatolithiasis concomitant with hepatocholangiocarcinoma was 2. 8% （ 24 of 860 cases ） , and all of the tumors were located in the area of the bile duct with hepatolithiasis. Biliary atypical epithelial hyperplasia and cholangiocarcinoma were simultaneously present in some of the pathological sections. In this series, the correct diagnostic rate of hepatolithiasis associated with a space-occupying lesion in the liver before operation by ultrasonograph was 40.9% ,by CT was 53.8% and by MRI/MRCP was 66.7% . 17 cases（70.8% ） were resected, and the radical resection rate was 33.3 % （8/24 ）. Palliative resection was done in 37.5 % of cases（ 9/24）. The 1 - and 3 - year survival rate was 62.5% , and 25.0% respectively, in the group of radical resection ; was 33.3 % and 11. 1% respectively, in the group with palliative resection ; and 0 % in the pathological biopsy group. Conclusions Long-term recurrent hepatolithiasis is an important cause for the development of hepatocholangiocarcinoma. The misdiagnostic rate of the disease was high, and the treatment results and prognosis were poor. It is important to pay more attention to the reasons for delaying the diagnosis of hepatolithiasis-related cholangiocarcinoma and take the appropriate preventative measures to assist in its early diagnosis.
出处
《中国普通外科杂志》
CAS
CSCD
2006年第3期170-172,共3页
China Journal of General Surgery
关键词
肝胆管结石
并发症
胆管肿瘤
肝
科学
Hepatolithiasis/compl
Bile Duct Neoplasms, Hepatic/surg
