肝内外胆管结石合并胆管癌的临床特征及诊治

Clinicopathological features,diagnosis and treatment of hepatolithiasis complicated with cholangiocarcinoma

目的探讨肝内外胆管结石合并胆管癌的临床特征及诊治方法。方法回顾性分析1998—2009年武汉大学中南医院收治的肝内外胆管结石合并胆管癌54例患者的临床资料。结果全组肝内外胆管结石合并胆管癌者的发生率为5.45%;术前诊断率为83.3%。54例均行手术治疗,其中根治性切除率38.9%;病理诊断为腺癌;45例患者(占总数的83.3%)术后平均随访24个月,行根治性手术病例平均存活21个月,行姑息性引流手术病例平均存活8.5个月,仅行探查术病例存活平均3.5个月。结论胆管癌伴有肝内外胆管结石的疗效较差,有可能时应力争行根治性切除。

Objective To discuss diagnosis and treatment of hepatolithiasis complicated with cholangiocarcinoma.Methods Fifty-four cases of hepatolithiasis complicated with cholangiocarcinoma from 1998 to 2009 treated in Zhongnan Hospital were collected and analysed.Results Cholangiocarcinoma occurred in 5.45% of patients with hepatolithiasis in our hospital group.The diagnosis was established preoperatively in 45 cases（83.3%）.All of 54 cases underwent surgery.Among them,21 cases（38.9%） of adenocarcinoma in bile duct underwent radically resected.At followed up of 45 cases（83.3%）,the average survival time of patients that underwent radical resection was 23 months and that of patients who underwent drainage was 8.5 months.Conclusions The therapeutic effect of cholangiocarcinoma complicated with hepatolithiasis is poor and,when possible,radical resection of the tumor should be undertaken.