影像学及CA19-9、CEA测定在肝外胆管癌诊断中的价值

The value of CA19-9,CEA and imaging in the diagnosis of extrahepatic cholangiocarcinoma.

目的探讨影像学检查和CA199、CEA的测定对肝外胆管癌(extrahepaticcholangiocarcinoma,EHCC)的诊断价值。方法回顾性分析1995～2003年107例肝外胆管癌US、CT、MRCP、ERCP、PTC诊断结果。其中51例进行了CA199、CEA的测定,并与42例胆道良性病变进行对照研究。结果US、CT、ERCP肿块显示率分别为708%、602%、690%;US、CT、MRCP、ERCP、PTC定位诊断准确率分别为729%、759%、100%、714%、769%。EHCC组与胆道良性病变组相比较,血清CA199、CEA和胆汁CA199值明显升高(P<001,P<005和P<001)。血清CA199、CEA和胆汁CA199的敏感性分别为863%、255%、409%,其特异性分别为875%、952%、788%。结论MRCP对EHCC诊断优于US、CT、ERCP及PTC,血清CA199的测定是EHCC术前可靠的定性诊断手段。

Objective To explore preoperative diagnostic value of different imaging methods,CA19-9 and CEA determination for extrahepatic cholangiocarcinoma (EHCC).Methods In 107 patients with EHCC admitted between 1995 and 2003,the diagnostic results of various imaging methods were analyzed retrospectively.CA19-9 and CEA concentrations of serum and bile in patients with EHCC (n=51) and benign biliary diseases (n=42) were measured as comparison.Results The preoperative diagnostic accuracy rates of tumor visualization of US,CT and MRCP in diagnosing EHCC were 70.8%,60.2% and 69.0% respectively.The diagnostic accuracy rates of tumor location of US,CT,MRCP,ERCP and PTC in diagnosing EHCC were 72.9%,75.9%,100%,71.4% and 76.9%.Serum CA19-9,serum CEA and bile CA19-9 concentrations were increased significantly (P<0.01,P<0.05 and P<0.05) in patients with EHCC compared with patients with benign biliary diseases.The sensitivity of serum CA19-9,serum CEA and bile CA19-9 in diagnosing EHCC were 86.3%,25.5% and 40.9%.The corresponding indexes of specificity when compared with the benign billiary disease group were 87.5%,95.2% and 78.8% respectively.Conclusion MRCP is superior to US,CT,ERCP and PTC.The serum CA19-9 determination is a reliable measure for preoperative diagnosis of EHCC.