肝胆管结石合并肝胆管癌的诊断及手术治疗

The diagnosis and surgical treatment of hepatolithiasis associated with cholangiocardnoma

目的探讨肝胆管结石与肝胆管癌的关系，以及该病的早期诊断和外科治疗措施。方法回顾性分析28例肝胆管结石合并肝胆管癌患者的临床资料。结果该组肝胆管结石合并肝胆管癌的发生率为5．9％，术前B超、CT及MRCP对肝胆管癌的诊断正确率分别为57．15％（16／28）、46．43％（13／28）、40．00％（6／15）。根治性手术12例，姑息性手术12例，单纯活检4例。根治性切除组术后1、2、3年生存率分别为83．34％（10／12）、58．34％（7／12），25．00％（3／12），姑息性切除组术后1、2年生存率分别为66．67％（8／12）、8．33％（1／12），单纯活检组2例，分别在术后6个月内死亡。结论胆管癌的发生与肝胆管结石有关；对年龄〉40岁、病史长、反复感染的肝胆管结石患者，短期内消瘦和难以解释的肝区疼痛者，应警惕并发肝胆管癌的可能。提高疗效的关键是早期诊断，早期治疗，争取根治性手术。

Objective To explore into the relationship between the hepatolithiasis and the intrahepatie cholangiocareinoma, and summarize the experience of early diagnosis and surgieal treatment of these disease. Methods A retrospective clinical analysis was made in 28 eases of hepatolithiasis complicated by intrahepafie eholangiocarei- noma from September 1998 to December 2008. Results It was found that the incidence of eholangiocarcinoma in hepatolithiasis was 5.9%. The correct rate of preoperative ultrasonic diagnosis was 57.15% （ 16/28 ） , and that of CT diagnosis was 46.43% （13/28） , and that of MRCP diagnosis was 40.00% （6/15）. 12 cases were radically resected, 12 cases were treated by palliative therapy,and 4 eases were examined only with biopsy,and all cases were followed up. The 1-,2-,and 3-year survival rate in radical surgery were 83.34% ,58.34% ,25.00% respectively. And the 1- year,and 2-year survival rate in palliative surgery group were 66.67% ,8.33% respectively. And all the eases examined only with biosy died in 6 months after the biosy. Conclusion Cholangiocarcinoma is related to hepatolithiasis. In patients of hepatolithiasis who were older than 40 years and have a long history of recurrent cholangitis ,weight-loss in a short period, progressive jaundice, or intractable abdominal pain, the possibility of accompanying eholangiocarcinoma should be considered. The key of improving the therapeutic effectiveness was early diagnosis ,early treatment and striving for radical operation.