肝门胆管癌的鉴别诊断

Differential diagnosis of hilar cholangiocarcinoma.

目的提高对肝门胆管癌诊断和鉴别诊断的认识,减少对其误诊误治。方法对上海中山医院1993年1月至1996年12月收治的33例术前诊断为肝门胆管癌的手术病例进行回顾性分析,根据病理结果,探讨影像学检查、肿瘤相关抗原、组织活检和细胞学检查以及手术探查对肝门胆管癌诊断和鉴别诊断的价值。结果根据病理结果,33例手术病例中有8例系其他肝门部梗阻性疾病被误诊为肝门胆管癌,误诊率占所有手术的24.2%。这8例被误诊患者中,包括肝门胆管癌栓3例,特发性良性狭窄2例,胆囊管癌累及肝总管1例,胆囊管残株癌1例,肝外胆管结核1例。结论虽然有较多的方法可用于肝门胆管癌的鉴别诊断,但临床误诊率仍较高。我们建议对所有肝门胆管癌病人,只要无手术禁忌证,均应积极手术探查。

Objective To improve the understanding of hilar cholangiocarcinoma and avoid er- rors in its diagnosis and treatment.Methods We retrospectively studied 33 operated patients with pre- operatively diagnosed hilar cholangiocarcinoma,who had been treated in our hospital from Jan.1993 to Dec.1996,and compared the diagnoses with their pathological results.The values of imaging examina- tion,tumor related antigen,tissue biopsy,cytologic examination and surgical exploration in the diagno- sis and differential diagnosis of hilar cholangiocarcinoma were discussed.Results According to patho- logical diagnosis,there were 8 misdiagnosed cases which were finally confirmed as other hilar obstructive diseases,including 3 cases of cancer embolus in the hepatic duct,3 idiopathic benign focal stenosis,I di- rect invasion of cystic duct carcinoma,1 residual carcinoma of cystic duct and 1 extrahepatic duct tuber- eulosis.The rate of misdiagnosis was up to 24.2%.Conclusions The rate of clinical misdiagnosis of hilar cholangiocarcinoma is still high although many methods have been used in differential diagnosis. We suggest surgical exploration should be applied to all of the suspected hilar cholangiocareinoma pa- tients on the premise of no contradiction.