黄疸前期胆管中下段癌的诊断和治疗

The diagnosis and treatment of the midcommon and distal bile duct carcinoma in the prejaundice stage.

对９５例胆管中下段癌进行了临床总结，并重点对９例黄疸前期获明确诊断和治疗者进行了分析。结果显示：７０５２％的胆管中下段癌有黄疸前期症状。这些症状持续时间从１个月至１９个月不等，主要为反复上腹部、右上腹部或腰背部隐痛或胀痛不适，伴或不伴有发热、食欲不振和体重减轻。黄疸前期的根治性切除率明显高于黄疸期（８／９比３９／８６，ｘ２＝４．５５９，Ｐ＜００５）。９例黄疸前期胆管中下段癌的临床特点为：①胆囊切除术后右上腹疼痛症状不缓解或明显加重，并伴胆管明显扩张；②“症状性胆囊结石”伴有不明原因的胆道扩张；③胆道Ｔ管外引流术后不能夹闭Ｔ管，或行“Ｏｄｄｉ括约肌缩窄”切开后短时间内症状再发或加重；④不明原因的反复右上腹隐痛或胀痛不适，且进行性加重。提示，黄疸前期胆管中下段癌有临床特点，其早期诊断有助于提高切除率和远期疗效。

?5 cases with the midcommon and distal bile duct carcinoma (MDBDC) including 9 who got eradical treatment in the prejaundice stage were clinically analyzed.The data revealed that 70.52% of the cases with MDBDC had systoms of the prejaundice stage.The systoms,lasting from 1 to 19 months,included repeated malaise of pain attack in the epigastrium,right epigastrium,or back,accompanied by fever,anorexia,loss of weight or not.The eradical resection rate of the prejaundiced patients was significantly higher than that of the jaundiced (8/9 vs 39/86,x2=4.559,P<0.05).The clinical characteristics of the 9 cases with MDBDC in the prejaundiced stage included ① the right epigatric pain sustained or even got severer after cholesystectomy;②unexplainable bile duct dilation accompanied by “Symtomatic”gallbladder stone;③unexplainable distal bile duct obstruction after exploration of commonbile duct or Oddi's sphincterotomy;④unexplainable upper epigastric malaise or pain.The data indicate that MDBDC in the prejaundiced stage has its own clinical charateristics for the early diagnosis,which is helpful to increase the resection rate and long-term results.