混合型肝胆管细胞癌的临床特点及诊治体会

The clinical profile of combined hepatocellular carcinoma and cholangiocarcinoma and its diagnosis and treatment:a report of 13 cases

目的探讨混合型肝胆管细胞癌(c HCC-CC)的临床特征和诊治经验。方法对2002年01月—2013年06月济南军区总医院收治经手术切除的13例c HCC-CC患者的临床资料进行回顾性总结分析。结果 13例均有乙型肝炎病史,11例(84.6%)合并结节性肝硬化,甲胎蛋白(AFP)阳性10例(76.9%),癌胚抗原(CEA)阳性4例(30.8%),糖链抗原(CA19-9)阳性3例(23.1%);中位生存期为32个月,1、3、5年生存率分别为76.9%、46.2%和7.7%。结论1c HCC-CC术前诊断困难;2疑诊为肝癌患者伴有血清AFP、CEA或CA199同时升高应考虑该病;3根治性手术切除及术后个体化综合性治疗是c HCC-CC的有效治疗手段。

Objective To summarize the clinical profile and the experience about diagnosis and treatment of combined hepatocellular carcinoma and cholangiocarcinoma（cHCC-CC）. Methods The clinical data of 13 cases of cHCC-CC from January 2001 to June 2010 in authors＇ Hospital were analysed retrospectively. Results Median age of the 13 cases was 49 years（ranged from 42 years to 63 years）,including 11 males and 2 females. All patients had a history of hepatitis B（100%）,and some had cirrhosis（84.6%）. The serum levels of alfa-fetaprotein（AFP）,carcino-embryonic antigen（CEA） and carbohydrate antigen199（CA199） were elevated in 10（76.9%）,4（30.8%） and 3 cases（23.1%）,respcectively. All patients were followed-up. The postoperative median survival time was 32 months,and the overall 1-,3- and 5- year survival rate of were 76.9%,46.2% and 7.7%,respectively.Conclusion It is difficult to diagnose cHCC-CC preoperatively,and the cases doubted as HCC clinically with elevation of serum CEA or/and CA199 should be considered as cHCC-CC firstly. Radical resection and comprehensive treatments after surgery are effective procedures for cHCC-CC.