肝内胆管囊腺癌17例临床分析

Intrahepatic biliary cystadenocarcinoma of 17 cases DAI

目的分析肝内胆管囊腺癌的临床特点及治疗，探讨影响预后的相关因素。方法回顾性分析2002年1月至2007年9月共17例经手术病理证实为肝内胆管囊腺癌的临床资料，并进行随访。对预后的影响采用Cox回归分析和Kaplan—Meier分析。结果17例中男4例，女13例，平均年龄为49．3岁。患者以上腹痛为主要临床表现，仅2例患者CA19—9异常，2例CEA异常，17例患者AFP均正常。17例中行根治性手术7例，肿瘤完全切除联合取瘤栓术7例，姑息性手术3例。病理提示胆管囊腺癌10例，胆管囊腺瘤局部癌变2例，乳头状胆管囊腺癌2例，黏液性乳头状胆管囊腺癌2例；1例为肝内胆管囊腺癌与肝细胞癌双结节混合性癌。17例中肿瘤高分化7例，中分化3例，低分化7例。手术方式（ β =-0．692，P=0．01）、肿瘤分化程度（p=-2．041，P=0．007）对预后影响有统计学意义。结论肝内胆管囊腺癌以成年女性多见。血清CA19-9对诊断无帮助。肝内胆管囊腺癌的胆总管癌栓并不预示临床预后差，行根治性手术或根治性切除联合取栓术均能有较好的预后。

Objective To explore the clinical features, treatment and prognosis of intrahepatic biliary cystadenocarcinoma （IBC）. Methods We retrospectively analyzed clinical data of 17 patients with pathologically confirmed IBC, treated between January 2002 and September 2007. Results Of the 17 patients, 4 were men and 13 were women, with a mean age of 49. 3 years （range 45 -68）. Serum level of AFP was normal in all patients. CA19-9 was abnormally elevated in only two patients and the other two had abnormal serum level of CEA. Seven cases underwent radical resection, 7 underwent complete tumor resection combined with removal of tumor thrombi in the bile duct, 3 received palliative surgery. On histopathological examination, 10 were biliary cystadenocarcinoma,2 were biliary cystadenoma with partial canceration,2 were papillary cystadenocarcinoma,2 were mucinous papillary cystadenocarcinoma and 1 was of mixed cystadenocarcinoma and hepatocellular carcinoma. According to tumor differentiation, the number of well, moderate and poor-differentiated group was 7, 3 and 7 cases respectively. The modality of surgery （ 13 = - 0. 692, P = 0. 01 ） and tumor differentiation （ β = - 2. 041, P = 0. 007 ） effected the prognosis significantly. Conclusions IBC occurs mainly in elderly women. CA19-9 examination does not help in the establishment of diagnosis of IBC. The occurrence of tumor thrombosis in common bile duct doesn＇t necessarily indicate poor prognosis, hence a IBC patient will still have a satisfactory prognosis should the primary tumor be completely resected and tumor thrombi removed.