肝内胆管细胞性肝癌临床特点分析90例

Clinical features of intraheptic cholangiocarcinoma:an analysis of 90 cases

目的:分析肝内胆管细胞性肝癌(intraheptic cholangio carcinoma,ICC)的临床特点,以期对临床诊治进行指导.方法:回顾分析我科1985-01/2003-01行手术探查的90例ICC患者临床资料.结果:64例患者有右上腹隐痛不适等非特异性症状表现;32例有乙肝病史;42例(46.7%)合并肝硬化.29例术前检查AFP为阳性;56例术前检查CA199为阳性;61例术前检查γ-GT增高.31例术前B超检查发现肝内占位合并肝门淋巴结肿大;58例术前CT检查提示肿瘤有典型的低血供表现.90例ICC患者中,38例行手术根治性切除,其1、3、5年生存率分别为81.1%、43.6%、43.6%.余52例行姑息性手术切除,其1、3、5年生存率分别为16.7%、0.0%、0.0%.结论:ICC临床表现多样,无明显特点.CA199阳性及γ-GT增高提示ICC可能.ICC易发生肝门淋巴结转移.B超和CT联合能发现病灶及明确病灶性质.ICC以手术治疗为主,根治性手术切除是保证长期生存的唯一途径.

AIM： To explore clinical features of intraheptic cholangiocarcinoma （ICC） and to guide clinical practice. METHODS： Clinical data of 90 cases with ICC undergoing surgery during 1985-01 and 2003-01 were retrospectively studied. RESULTS： Sixty two patients had chief com- plaint of abdominal pain. Thirty two patients had HBV infection history, and 42 patients experienced cirrhosis. Before operation, AFP was positive in 29 cases and CA199 was positive in 56 cases, and γ-GT was significantly increased in 61cases. Thirty one patients and 58 patients had characteristic B-mode manifestation and CT manifestations. Statistic analysis demonstrated that 1-, 3-, 5-year survival rates for patients who underwent radical operation were significantly different those who underwent palliative operation （81.1% vs 16.7%, 43.6% vs 0.0%, 43.6% vs 0.0%, all P 〈 0.01） CONCLUSION： ICC has non-specific clinical manifestations. CA199 and r-GT are useful in the diagnosis of ICC. B-mode ultrasonography and CT are important for diagnosis of ICC. The radical surgical resection is the only method to ensure a long-term survival.