继发于肝内胆管结石症的肝胆恶性肿瘤27例分析

Secondary hepato-biliary malignancy in patients suffering from hepatolithiasis: report of 27 cases

目的探讨继发于肝内胆管结石的肝胆系统恶性肿瘤的发病率、临床特点和预防方法。方法对合并肝内胆管结石的肝胆恶性肿瘤患者进行临床回顾性研究。结果自 1996～ 2 0 0 0年连续收治 5 5 6例肝内胆管结石患者 ,其中 2 7例合并存在肝胆系统恶性肿瘤 ,其平均发病率为 4 8%。本组术前明确诊断仅 4例。肝内胆管结石继发恶性肿瘤的临床表现包括非典型肝脓肿、难以控制的感染、不明原因的进行性黄疸、CT和B超检查中可疑的肿瘤性改变和腹部肿块。本组患者以中晚期病例为主 ,仅 3例患者作了肿瘤切除术。结论肝内胆管结石继发恶性肿瘤的概率较高 。

ObjectiveTo investigate the incidence, clinical features and preventive measurement of secondary hepato-biliary neoplasm (HBN) in patients with hepatolithiasis. MethodA clinical retrospective study was made on 27 hepatobiliary malignancy patients found among 556 consecutively admitted cases of hepatolithiasis from Jan. 1996 to Sep. 2000.Results The average incidence of hepatobiliary malignancy in patients with hepatolithiasis is 4.8%. In this series, preoperative definite diagnosis was made in 4 cases (4/27, 14.8%). Atypical liver abscess, refractory biliary system infection, progressive obstructive jaundice, CT or BUS scan abnormal findings, and epigastric masses are all clues to concurrent malignancy in patients of hepatolithiasis. ConclusionThere is high incidence of hepatobiliary malignancy in hepatolithiasis patients. Prophylactic partial hepatectomy for segments with stone and chronic infection may be an important measure to prevent ensuing malignancy.