43例肝内胆管细胞癌的临床特点及治疗

Clinical features and treatment of 43 patients with intrahepatic cholangiocarcinoma

目的分析肝内胆管细胞癌(ICC)的临床特点及治疗选择。方法回顾性分析43例经手术后病理证实为ICC患者的临床资料。结果 ICC患者无典型的临床症状。30%的患者CEA阳性,28%的患者HBsAg阳性,30%的患者有肝硬化,12%的患者AFP阳性;影像学检查有特征性表现,但确诊率不高,超声联合CT检查判断恶性病变的准确率可达到93%。43例中有40例根据患者的肝脏背景行规则性或不规则性肝切除术,2例行无水酒精注射,1例仅行剖腹探查。行肝切除术患者的1、3、5年生存率分别为66.5%、32.6%和27.2%。结论 ICC患者无典型的临床症状,CEA和(或)CA199阳性有助于诊断;有肝炎、肝硬化或者AFP阳性的患者应考虑有ICC的可能;影像学检查确诊ICC较为困难,但对于选择是否手术有较高价值;根治性肝切除术是最佳的治疗选择。

Objective To analyze the clinical features and proper treatment of intrahepatic cholangiocarcinoma（ICC）.Methods The clinical data of 43 consecutive patients with ICC treated in our hospital were retrospectively analyzed.Results Patients with ICC had no distinct clinical features.Of the 43 patients,CEA level was increased in 30%,HBsAg was positive in 28%,AFP was elevated in 12%,cirrhosis was diagnosed in 30%.Imaging examinations demonstrated characteristic features in some patients,but were difficult in the diagnosis of ICC.The accuracy of diagnosing malignant lesions was 93% by Ultrasound combined CT.Anatomic liver resection or nonanatomic liver resection were actually performed in 40 patients according to their different conditions of liver;ethanol injection was performed in 2 patients;operative exploration was performed in 1 patient.The accumulative 1-,3-and 5-year survival rates of the 40 patients after resection were 66.5%,32.6% and 27.2%,respectively.Conclusion ICC has no specific clinical manifestation,the elevation of CEA or CA199 were helpful in the diagnosis of ICC;there is a possibility that patients with hepatitis,cirrhosis or AFP-positive could suffer from ICC.Imaging findings are difficult in the diagnosis of ICC,but are of great value in defining the indications for surgery.Radical resection is the most optimal treatment for patient with ICC.