肝胆管结石合并胆管癌(附16例临床报告)

The cholangiocarcinoma accompanying hepatolithiasis: a clinical report of 16 cases.

目的 探讨肝胆管结石合并胆管癌的诊断、治疗和预后。方法 对我院近 14年来收治的肝胆管结石合并胆管癌 16例作回顾性研究。男 13例 ,女 3例 ,平均年龄 5 5 8岁 ;肝内胆管结石 7例 (43 8% ) ,肝内及肝外胆管结石 9例 (5 6 3% )。分析其临床及病理资料 ,并予随访。结果 胆管癌在肝胆管结石病人的发生率为 2 7% (16 / 5 87) ;术前诊断正确率 5 0 0 % (8/ 16 ) ;胆管腺癌 11例 ,其中高分化腺癌 7例 ;肝内胆管癌占 18 8% ,肝门部胆管癌占 43 8% ,肝外胆管癌占 31 2 % ,壶腹部癌占6 2 % ;根治性切除肿瘤 4例 (2 5 0 % ) ,平均生存 2 4个月 ,姑息性手术 12例 (75 0 % ) ,平均生存 3个月。结论 对 5 0岁以上 ,病史较长 ,反复胆管炎发作 ,短期内消瘦 ,进行性黄疸加重 ,腹痛难控制的肝胆管结石病人 ,应高度警惕并发胆管癌的可能。提高肝胆管结石合并胆管癌疗效的关键是早期诊断、早期治疗 ,争取根治性切除。

Objective To analyse the diagnosis, treatment and prognosis of cholangiocarcinoma accompanying hepatolithiasis. Methods Sixteen patients (13 males and 3 females, with a mean age of 55 8 years) of cholangiocarcinoma accompanying hepatolithiasis treated in our hospital within recent 14 years were studied. Seven of them had stones in intrahepatic ducts (43 8%), and nine in intra- and extra-hepatic ducts (56 3%). The clinical, pathological and follow-up data were reviewed retrospectively. Results It was found that the incidence of cholangiocarcinoma in hepatolithiasis was 2 7%. Fifty percent of these patients were correctly diagnosed preoperatively. Eleven cases had adenocarcinoma, in which 7 were well differentiated adenocarcinomas. Tumors occurred in different sites: 18 8% were intrahepatic, 43 8% were at the hepatic porta, 31 2% were extrahepatic and 6 2% were at the ampulla. Only 4(25 0%) cases were radically resected, and their average survival time was about 24 0 months. Twelve (75 0%) cases were subjected to palliative operations and the average survival time was about 3 0 months. Conclusion In patients of hepatolithiasis who are older than 50 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 cholangiocarcinoma should be considered. The key to improve the therapeutic effectiveness is early diagnosis, early treatment and striving for radical operation.