肝外胆管癌206例诊断分析

Diagnosis of extrahepatic bile duct carcinoma:an analysis of 206 cases

目的探讨肝外胆管癌的诊断程序,提高其诊疗水平。方法对1995年6月至2004年10月206例经手术证实的肝外胆管癌进行回顾性分析。结果(1)肝外胆管癌初诊时多以黄疸为首发症状,其他常见症状依次有上腹部隐痛(49.5%)、乏力(30.6%)、消瘦(27.2%)、厌食(13.1%)。(2)实验室检查碱性磷酸酶(AKP),γ-谷氨酰转移酶(γ-GT),糖类抗原(CA19-9)阳性率分别为100%(206/206)、93.7%(193/206)和68.4%(140/206)。(3)影像学检查中联合B超+CT、血管造影(CTA)+磁共振胰胆管成像(MRCP)+逆行性胰胆管造影(ERCP)或经皮肝穿刺胆管造影(PTC)对肝外胆管癌的确诊率为100%,2例早期胆管癌均是通过ERCP确诊的。结论建立规范的肝外胆管癌诊断程序,是改善肝外胆管癌愈后的关键。

Objective To study the diagnosis program of extrahepatic bile duct carcinoma in order to improve the level of its diagnosis and treatment. Methods The clinical data of 206 cases of extrahepatic bile duct carcinoma validated by operation admitted between June 1995 and October 2004 was analyzed retrospectively. Results （ 1 ） Jaundice was usually the first symptom in extrahepatic bile duct carcinoma. Other symptom included abdominal hidden pain （49. 5% ）, atony （30. 6% ）,fleshless（27.2% ）and inappetence （13. 1% ）. （2）Among the lab examinations,the positive rate of AKP,γ- GT and CA19 - 9 were 100% （206/206） ,93. 7% （ 193/206 ） and 68. 4% （ 140/206 ） respectively. （ 3 ） Among manifold imaging,the according rates were 100% in adopting B - US ＋ CT ＋ MRCP/PTC and B - US ＋ CT ＋ MRCP ＋ ERCP groups. Two cases of early extrahepatic bile duct carcinoma were diagnosed by ERCP. Conclusion To set up the diagnosis criterion of extrahepatic bile duct carcinoma is the key of improving its prognosis.