肝内胆管囊腺瘤与囊腺癌临床特征及预后比较

Comparison of clinical characteristics and prognosis between biliary cystadenoma and biliary cystadenocarcinoma

目的比较肝内胆管囊腺瘤(biliary cystadenoma,BCA)与肝内胆管囊腺癌(biliary cystadenocarcinoma,BCAC)的临床特征差异,并探讨影响预后的相关因素。方法回顾性分析2005年1月-2014年12月39例鞍山市中心医院与解放军总医院经术后病理证实肝内胆管囊腺瘤与肝内胆管囊腺癌患者的临床特征、实验室检查结果、影像学特征、治疗方式及预后。结果 39例中男性7例,女性32例,年龄7~77(47.3±15.5)岁。其中肝内BCA 23例,BCAC 16例。BCAC较BCA更易出现肝功能异常(P<0.05)。影像学特征:BCAC较BCA更易出现囊内实性结构(10/16 vs 7/23,P=0.047),在包膜完整性、囊内分隔、肿瘤内钙化、包膜或分隔强化方面差异无统计学意义(P均>0.05)。所有患者均行手术治疗,肿瘤完整切除32例,肿瘤未完整切除7例。29例患者获得随访,中位随访时间40(3~124)个月,BCAC组中位生存时间为41个月。结论二者术前鉴别诊断较为困难,诊断依据术后病理。肝内胆管囊性肿瘤好发于中年女性患者,BCAC预后较差。

Objective To compare the clinicopathological features of biliary cystadenoma （BCA） with those of biliary cystadenocarcinoma （BCAC）, and explore the related factors of prognosis. Methods Clinical data about 39 patients with clinicopathologically confirmed BCA or BCAC in Chinese PLA General Hospital and Anshan Central Hospital from January 2005 to December 2014 were collected and reviewed, their clinical features, laboratory examination, radiologic findings, surgical treatment and prognosis were compared. Results Thirty-nine patients with pathologically diagnosed BCT （BCA, n=23; BCAC, n=16） were included （7 males and 32 females）, with an average age of （47.3 ± 15.5） years （7-77 years）. The postoperative pathological examination confirmed 23 cases of BCA and 16 cases of BCAC. BCAC was significantly more frequently associated with liver dysfunction compared with BCA （P 〈 0.05）. Though the presence of mural nodule was significantly more frequent in the BCAC group than in the BCA group （10/16 vs 7/23, P=0.047）, the radiologic findings in other aspects such as capsule wall integrity, septa, calcification, wall or septa enhancement showed no significant differences （All P 〉 0.05）. All patients underwent surgical resection while 32 patients had complete resection and 7 patients had incomplete resection. Twenty-nine patients were followed up with a median of 40 months （3-124 moths）, and the median survival time of BCAC group was 41 months. Conclusion Preoperative differential diagnosis in BCA and BCAC still remains difficulties, and accurate diagnosis should be based on postoperative pathology. BCT occurs predominantly in middle-age women, and the prognosis of BCAC is poor.