肝胆管结石合并胆管癌漏诊及防治(附52例分析)

Prevention and treatment of cholangiocarcinoma accompanied with hepatolithiasis(52 cases)

目的探讨肝胆管结石与胆管癌的关系,总结该病的漏诊原因及防治经验。方法回顾性分析1998年1月～2010年12月经病理证实的52例肝内胆管结石合并胆管癌的临床资料,并对其诊断、治疗和预后进行总结。结果 52例胆管癌的发生率占同期肝内胆管结石患者的4.17%(52/1248)。其中,术前诊断者17例,术前诊断正确率32.7%(17/52),术前漏诊率达67.3%(35/52)。术前漏诊的35例中,26例经术中探查结合病理切片得到确诊,7例术中未发现但术后病理证实为胆管癌,其余2例为取石及肝叶切除术后数月病情恶化,再次手术得以证实。术前及术中诊断的患者有21例获得根治性切除,切除率为40.4%(21/52)。肝胆管癌行根治切除者平均生存34.2个月(14～65)个月;仅作姑息性内或外引流者平均生存11.7个月(3～14个月);仅作剖腹探查者平均生存2个月(1～4个月)。结论肝内胆管结石合并胆管癌的早期诊断困难,漏诊率高。根治性切除较姑息性手术能显著提高患者的生存率和生存质量。重视该病,早期诊断、早期治疗,争取根治性切除能提高肝胆管结石合并胆管癌疗效。

[Objective] To explore the relationship between cholangiocareinoma and hepatolithiasis, summarize the reasons of misdiagnosis, prevention and treatment of cholangioearcinoma accompanied with hepatolithiasis. [Methods] Fifty two patients bearing cholangiocarcinoma accompanied with hepatolithiasis treated in Xiangya Hospital from ]an 1998 to Dec 2010 were studied. The clinical, pathological and follow-up data of the patients were reviewed retrospectively. [ Results ] The incidence of cholangiocarcinoma companying with hepatolithiasis was 4.17% （52/1248）. The percentage of preoperative correct diagnosis was 32.7% （17/52）, while the misdiagnosis rate was 67.3% （35/52）. Among the 35 cases of misdiagnosis, 26 cases were verified pathologically during the operation, 7 cases were verified pathologically after the operation, and other two cases were correctly diagnosed by re-operation only after the recurrence of the tumor several months later. The rad- ical operation was carried out in 40.4% （21/52） of the patients. The overall average survival time was about 34.2 months （14-65 months） and 11.7 months （3-14 months） for patient accepted radical or palliative operations respectively. For patients accepted only exploring operations, the average survival time was about 2 months （1-4 months）. [Conclusion] Cholangiocarcinoma companying hepatolithiasis is difficult to be diagnosed in the early stage. In patients of hepatolithiasis who are older than 45 years and have a long history of recurrent cholangitis, progressive jaundice, or intractable abdominal pain, the possibility of accompanying cholan-giocarcinoma should be considered. The key to improve the therapeutic effectiveness is early diagnosis, early treatment and striving for radical operation.