肝胆管结石合并胆管癌的诊治分析

The analysis of the clinical characteristics and different diagnosis and therapeutic methods of hepatolithiasis with cholangiocarcinoma

目的探讨肝胆管结石合并胆管癌的诊断、治疗和预后。方法对广州市花都区人民医院近10a来收治的肝胆管结石合并胆管癌21例诊治情况作回顾性研究。结果胆管癌在肝胆管结石患者的发生率为3．3％；术前诊断正确率61．9％；CA199阳性率为76．2％，术前诊断正确率B超为56．3％，CT为67．8％，MRI／MRCP为82．3％，根治性切除肿瘤42．8％，姑息性手术57．2％，根治性切除肿瘤1、2、3a生存率分别为91．3％、71．5％和50．7％；姑息性手术1、2、3a生存率分别为30．3％、18．4％和0．00％。结论肝胆胆管癌患者中血清CA199升高的敏感性、特异性较高，对胆管癌的患者的诊断有较高的价值；且血清CA199在监测术后复发中也具价值。肝胆管结石合并胆管癌根治性手术能明显延长患者寿命，疗效的关键是早期诊断、早期治疗，争取根治性切除。

Objective To explore the clinical characteristics and different diagnosis and therapeutic methods of hepatolithiasis with cholangiocarcinoma. Methods The clinical data of 21 patients with hepatolithiasis and cholangiocarci- noma were retrospectively analyzed. Follow up data were available for all the patients. Results The occurrence rate of the hapatolithiasia concomitant with cholangiocarcinoma was 3.3%. the positive rate of CA199 was 76.2%. In this series, the correct diagnostic rate of hepatolithiasis associated with aspace-occupying lesion in the liver before op- eration by ultrasonograph was 56.3% ,by CT was 67.8% and MRI/MRCP was 82.3%. The radical resection rate was 42.8 %0 and the palliative resection was 57.2%. The cumulative survival rate sat the lst,2nd and 3rd year after radical resection were91.3 %, 71.5 %, and 50.7 % respectively. The cumulative survival rate sat the 1st , 2nd and 3rd year after palliative resection were 30.3 %, 18.4% and 0.00 % respectively. There was no 1 year cumulative survival rate in non- operation patients. Conclusion Long-term recurrent hepatolithiasis , postoperation of biliary tract cholidocholithisis with cholangiocarcinoma ,positive CA199 are helpful for the diagnosis of cholangiocarcinoma. Operative removal can improve the survival rate.