肝胆管结石并发胆管癌

Hepatolithiasis combined with cholangiocarcinoma

目的 探讨肝胆管结石并发胆管癌的诊断、治疗和预后。方法 回顾性分析 17例肝胆管结石并发胆管癌的临床资料、病理及预后情况。结果 胆管癌在肝胆管结石病人中的发生率为 5 % (17 34 0 )。术前诊断为胆管癌者占 17 6 % (3 17)。肝内及肝门部胆管癌占88 2 % (15 17) ,肝外胆管癌占 11 8% (2 17)。其中高分化腺癌 9例。根治性切除 41 2 %(7 17) ,平均生存 2 6个月 ;姑息性内引流术 47 1% (8 17) ,平均生存 12 4个月 ;姑息性外引流术 11 7% (2 17) ,平均生存 3 6个月。结论 对病史长 ,反复胆管炎发作 ,短期内消瘦 ,黄疸加深 ,腹痛难以控制的肝胆管结石病人 ,应考虑胆管癌的可能。胆管癌切除预后较未切除者为好 ,姑息性内引流术的预后优于外引流术。

Objective To study the diagnosis, treatment and prognosis of hepatolithiasis combined with cholangiocarcinoma. Methods The clinical, pathological and follow up data of 17 cases of hepatolithiasis combined with cholangiocarcinoma were retrospectively analysed. Results The results showed that the incidence of cholangiocarcinoma in hepatolithiasis was 5% in this series. 17.6% of the patients were diagnosed as cholangiocarcinoma preoperatively. Tumor occurring in intrahepatic ducts was 88.2% and in hepatic porta ducts 11.8%. Nine cases were well differentiated adenocarcinomas. Only 7(41.2%) cases were radically resected and their average survival time was 26.0 months. Eight(47.1%) patients underwent internal drainage with average survival time 12.4 months. 2(11.7%) cases subject to external drainage with survival time 3.6 months. Conclusions If patients with hepatolithiasis have a long history of recurrent cholangitis, weight loss in a short period, progressive jaundice or intractable abdominal pain, the possiblility of combined with cholangiocarcinoma should be considered. Resection of the tumor has a better prognosis than that of tumor unresected; and the prognosis of internal drainage is better than that of external drainage.