肝胆管囊腺瘤和囊腺癌诊治7例

Diagnosis and treatment of hepatobiliary cystadenoma and cystadenocarcinoma: an analysis of 7 cases

目的:探讨肝胆管囊腺瘤和囊腺癌临床特征、诊断方法及外科治疗.方法:回顾性分析2003-02/2007-02中国医科大学附属第一临床医院收治的肝胆管囊腺瘤患者3例及肝胆管囊腺癌4例的临床资料.结果:肝胆管囊腺瘤3例均为女性,右上腹部隐痛不适,剑突下疼痛和腹胀.肿瘤标志物CA19-9升高(2/3),AFP无升高,肝脏囊性占位性病变,伴有分隔以及钙化影,平均最大直径17cm.术后随访26mo,未见复发.肝胆管囊腺癌4例,男性1例,女性3例,右上腹部隐痛和腹胀.肿瘤标志物CA19-9升高(2/4),AFP无升高,肝脏的囊性占位性病变伴有不规则分隔外,囊壁结节以及乳头状突起,平均最大直径13cm.其中3例行根治性切除术,已随访12mo,无复发或转移.结论:肝胆管囊腺瘤和囊腺癌早期诊断困难,肿瘤标志物及影像学检查有助于其诊断和鉴别,手术切除为最有效的治疗手段.

AIM： To discuss the clinical features, diagnostic method and surgical treatment of hepatobiliary cystadenoma and cystadenocarcinoma. METHODS： The clinical data of patients with hepatobiliary cystadenoma （n = 3） or hepatobiliary cystadenocarcinoma （n = 4） admitted to our hospital from February 2003 to February 2007 were analyzed. RESULTS： All the 3 patients with hepatobiliary cystadenoma were female. Abdominal pain and distention were common symptoms. Two of them had an elevated of CA19-9 level, but not AFP level. CT scan showed cyst occupying lesions with separations and calcifications in all the 3 patients. Mean maximal diameter of the cysts was 17 cm. All of themunderwent hepatectomy and no recurrence was found after following up for 26 mo. Hepatobiliary cystadeno-carcinoma was found in 1 male and 3 females. Two of the 4 cases had an elevated CA19-9 level. CT scan showed cyst occupying lesions with separations as well as cyst wall fibrosis. The mean maximal diameter of the cysts was 13 cm. Three of them underwent hepatectomy without recurrence or metastasis after following up for 12 mo. CONCLUSION： Tumor markers and imaging findings may help to make early diagnosis and differential diagnosis of hepatobiliary cystadenoma and cystadenocarcinoma. Complete resection is a better choice so far.