无黄疸期胆道扩张在壶腹周围癌中的诊断意义(附16例报告)

Diagnostic significance of anicteric biliary tract dilatation in periampullary carcinoma(16 cases report)

目的 探讨无黄疸期胆道扩张病人在壶腹周围癌的早期诊断 ,治疗方面的意义。方法 回顾总结 1986年 10月至 1999年 4月通过B超、CT、PTC等检出的 16例无黄疸胆道梗阻性扩张的壶腹周围癌病人切除率及生存率。结果 16例病人手术切除率 87.5 0 % ( 14 / 16) ,5年生存率 43.75 % ( 7/ 16) ,3年生存率 62 .5 0 % ( 10 / 16)。结论 壶腹周围癌病人胆道系统扩张在黄胆出现之前 ,上腹部饱胀不适、隐痛、胀痛、食欲不振等症状在黄疸前 1～ 3个月即可出现。对于出现上述症状 ,年龄超过 40岁 ,B超、CT、PTC、ERCP发现胆道扩张的病人应高度怀疑壶腹周围癌的可能 ,应及早手术探查 ,可明显提高切除率及生存率。

Objective To study significance of anicteric biliary tract dilatation in early diagnosis and treatment of patients with periampullary carcinoma.Method Review the resection rate and survival rate of 16 periampullary carcinoma patients with anicteric biliary tract obstruction found out by B-ultrasound,CT or PTC during 13 years(1986-1999).Result The operative resection rate was 87.50%(14/16) ,5-year survival rate was 43.75%(7/16),3-year survival rate was 62.50%(10/16).Conclusions Biliary tract dilatation existed before icterus occurred,while syndromes such as upset of upper abdomen,reclusion, epigastralgia distention and anorexia, may occur 1-3 months ahead of icterus occurred in patients with periampullary carcinoma. If the patient has syndromes mentioned above, more than 40 years of age and biliary tract dilatation found by B-ultrasound, CT,PTC or ERCP, periampullary carcinoma should be considered. The patients should be checked by operation,so as to raise the operative resection rate and survival rate.