摘要
目的 探讨肝门部胆管癌的诊断和治疗方法。方法 术前 5 5例行B超、彩色超声、血CEA、CA19 9测定。 40例行MRI和磁共振胆道成像检查 ,采用MTT法对 2 8例行肿瘤化疗药物敏感性测定。结果 根据本组病例的资料 ,肝门部胆管癌的术前诊断可分两步进行。用B超结合临床资料对患者进行筛选 ,然后进行三项检查 :(1)血清CA19 9值测定 (>2 2 2KU/L者 39例 ) ;(2 )彩色超声 ;(3)MRI和磁共振胆道成像。如果两项以上检查结果阳性 ,则可基本确诊为肝门部胆管癌。术前诊断准确率为 93% (37/4 0 )。根治性切除组 1年、2年、3年生存率分别为 92 % (12 /13)、92 % (12 /13)和5 0 % (6 /12 ) ,而在肿瘤部分切除、联合应用镍钛记忆合金胆道内支架、区域动脉灌注化疗组则分别为6 5 % (11/17)、33% (4/12 )和 17% (1/6 )。结论 凡无手术禁忌证的患者均应开腹探查。肿瘤部分切除联合应用镍钛记忆合金胆道内支架行区域动脉灌注化疗也可取得较好的姑息治疗效果。
Objective To evaluate the diagnostic and therapeutic methods for hilar cholangiocarcinoma. Methods In 55 patients ultrasonography, color Doppler flow imaging, serum CEA, CA 19 9 determination were used before operation. MRI combined with MRC was used in 40 patients, and tumor chemosensitivity to anticarcinogens was tested using MTT assay in 28 patients.Results Preoperative diagnosis of hilar cholangiocarcinoma should be approached through 2 steps: firstly all patients were screened by ultrasonography and analysis of clinical features, and secondly the following diagnostic methods are used: (1)measurement of serum CA 19 9 (a value>222?KU/L is judged as positive);(2)color Doppler flow imaging;(3)MRI combined with MRC. Two or more positive results are indicative of hilar cholangiocarcinoma. The preoperative diagnostic accuracy was 93%(37/40). In the radical resection group, the 1,2, and 3 years survival rates were 92%(12/13), 92%(12/13),and 50%(6/12) respectivly, while in the group undergoing palliative resection of the tumor combined with sharp memory nickel titanium alloy biliary endoprostheses, and regional arterial infusion chemotherapy the 1,2,and 3 years survival rates were 65%(11/17), 33%(4/12),and 17%(1/6) respectivly. [WT5”HZ]Conclusion[WT5”BZ] Laparotomy must be performed in all patients while there were no contraindications. Combined palliative measures plus regional chemotherapy also help in prolonging survival.
出处
《中华普通外科杂志》
CSCD
2000年第10期581-584,共4页
Chinese Journal of General Surgery
