肝内胆管囊腺癌15例临床分析

Biliary Cystadenocarcinoma:A Clinical Analysis of 15 Cases

目的探讨肝内胆管囊腺癌的临床表现、影像及病理特点、诊断及治疗。方法回顾分析我院1993年～2004年12年间收治的肝内胆管囊腺癌病例资料15例。结果临床表现为上腹疼痛10例(10/15),上腹部包块3例(3/15),体重下降2例(2/15),合并胆管炎1例(1/15)。影像学多见肝内单囊或多囊分隔状病变,可见乳头状突起物。术前误诊11例,误诊率达73%。10例获得根治性切除(10/15),仅2例肿瘤复发。结论结合肝内胆管囊腺癌相对特异的影像学特点,可以提高胆管囊腺癌的术前诊断率。肝内胆管囊腺癌手术切除率高,如能根治切除将获得较好的预后。故临床上遇到影像学可疑胆管囊腺癌病例时,应早期积极手术治疗,以提高根治性切除率。

Objective To clarify the clinical manifestation,radiologic and pathologic features,diagnosis and management of biliary cystadenocarcinoma.Methods The data of 15 patients with biliary cystadenocarcinoma from Chinese PLA General Hospital from January1993 to December 2005 were reviewed retrospectively.Results The clinical manifestations included epigastric pain in 10 cases（66.7 %）,mass in 3 cases（20 %）,weight loss（13.3 %） and complication of cholangitis（6.7 %）.The radiologic studies suggested an intrahepatic single cyst or multilocular and septate cystic lesion,usually with papillary excrescences.There were 11 cases misdiagnosed,with a misdiagnosis rate of 73% before operation.Ten patients underwent radical resection,and tumor recurrence occurred only in 2 cases.Conclusion Improvement in pre-operative diagnosis can be achieved by combination with specific radiologic features.The radical resection of this disease can get a high respectable rate and a good prognosis.So for a suspicious biliary cystadenocarcinoma,the early positive surgery treatment should be done to enhance the permanently curing respectable rate.