胆总管结石合并远端胆管肿瘤漏诊病例临床诊治体会

The clinical diagnosis and therapeutic features of distal bile duct cancer associated with missed diagnosis of choledocholithiasis

目的：探讨胆总管结石合并远端胆管肿瘤漏诊病例的临床诊治特点。方法回顾性分析8例漏诊的胆总管结石合并胆管肿瘤患者的临床资料。结果本组病例中漏诊的远端胆管恶性肿瘤6例，良性肿瘤2例，分别占同期胆总管结石病例的0．269％和0．09％。4例根治术患者生存期均超过3年，2例良性肿瘤患者随访2年未发现癌变。结论胆道镜或胆道造影可减少胆总管结石合并远端胆管肿瘤的漏诊率，且优于其他检查手段。漏诊病例多处于肿瘤早期，及时采取根治性手术可取得良好的预后效果。

Objective To investigate the clinical diagnosis and therapeutic features of distal bile duct tumor associated with missed diagnosis of choledocholithiasis.Methods The clinical data of 8 cases of distal bile duct tumor associated with missed diagnosis of choledocholithiasis were retrospectively analyzed.Results Missed diagnosis of biliary malignant tumor occurred in 0.269% of the patients who were diagnosed with choledocholithiasis, while the benign tumor was 0.09%.Four cases of radical mastectomy patients survived more than 3 years.Two benign cases were followed up without canceration in 2 years.Conclusions The application of choledochoscope and cholangiography can reduce the rate of missed diagnosis of distal bile duct tumor associated with choledocholithiasis and have an advantage over other medical examinations.The cases with missed diagonsis are usually in early stage of cancer and can have a good survival if they receive radical surgery on time.