肝胆管结石合并胆管癌的诊断与治疗(附62例报告)

DIAGNOSIS AND TREATMENT OF HEPATOLITHIASIS COMPLICATED WITH CHOLANGIOCARCINOMA:A REPORT OF 62 CASES

目的总结并探讨肝胆管结石合并胆管癌的诊治经验。方法总结2000～2008年第三军医大学西南医院收治的62例肝胆管结石合并胆管癌病人的临床资料。结果本组病例中肝胆管结石合并胆管癌都发病率为发生率5.45%;术前诊断率为85.5%(53/62);根治性手术率38.7%(24/62);病理诊断为胆管腺癌及粘液癌;随访45例,行根治性手术病例平均存活23个月,行引流术病例存活平均存活8个月,仅行探查术病例存活平均4个月。结论胆管癌的发生与肝胆管结石有关;伴有结石的胆管癌疗效较差,应重视胆管结石的早期根治性治疗,以防止胆管癌的发生;姑息性手术可提高生活质量。

Objective To discuss diagnosis and treatment experience of hepatolithiasis complicated with cholangiocarcinoma. Methods Data of 62 cases of hepatolithiasis complicated with cholangiocarcinoma from 2000 to 2008 in Southwest Hospital of Third Military Medical University were collected and analysed. Results Cholangiocarcinoma occurred in 5.45% of patients with hepatolithiasis in this group. The diagnosis was established preoperatively in 53 （85.5%） cases. Twenty-four cases of adenocarcinoma and mucocarcinoma in bile duct were radically resected. Forty-five cases were followed up. The average survival time of patients performed radical resection was 23 months, and that of patients performed drainage was 4 - 8 months. Conclusion Cholangiocarcinoma may be related to hepatolithiasis. The therapeutic effect of cholangiocarcinoma complicated with hepatolithiasis was poor. Early radical therapy for hepatolithiasis play an important role in preventing cholangiocarcinoma occurrence. Drainage therapy for cholangiocarcinoma may improve quality of live.