肝内胆管囊腺癌与囊腺瘤的术前鉴别诊断

A retrospective and comparative study of intrahepatic biliary cystadenoma and cystadenocarcinoma:differential diagnosis

目的肝内胆管囊腺瘤与囊腺癌术前无创鉴别诊断十分困难,本文目的在于探讨肝内胆管囊腺瘤与囊腺癌的鉴别诊断。方法回顾分析15例囊腺癌和24例肝内胆管囊腺瘤的临床资料,包括患者性别、年龄、症状、症状持续时间、肿瘤标记物、影像学特点等资料,应用统计学方法进行比较分析。结果囊腺癌男10例,女5例,年龄(57.93±14.39)岁;囊腺瘤男4例,女20例,年龄(43.75±12.51)岁,性别与年龄比较有统计学差异(P均为0.002);症状有无、病程长短以及CA199、CEA对比分析无明显统计学差异。囊腺癌组有14例位于肝左叶,囊腺瘤组有16例位于肝左叶(P=0.115)。肿瘤最大径分别为(7.38±3.98)cm、(10.21±7.82)cm(P=0.293)。囊腺癌组合并胆管扩张的有5例(5/11),而囊腺瘤组只有1例(1/21)合并胆管扩张(P=0.011)。其他影像学特点无明显统计学意义。结论年龄偏大的男性,病灶合并邻近胆管扩张有助于诊断肝内囊腺癌,CA199、CEA以及临床表现、其他影像学特点对鉴别诊断帮助不大。

Objective To give a tactics to differ intrahepatic biliary cystadenomas from cystadenocarcinomas in diagnosis.Methods Patients with a pathological diagnosis of cystadenocarcinomas and hepatobiliary cystadenomas were retrospectively reviewed from January 1991 to July 2012.Data including patients'gender,age,symptoms,duration of symptoms,tumor markers and imaging were comparatively analyzed.Results Thirty-nine patients had pathologically diagnosed intrahepatic biliary cystadenocarcinomas[15/39,10 males and 5 females,mean age:(57.93±14.39)years]or cystadenomas[24/33,4 males and 20 females,mean age:(43.75±12.51)years].Significant differences were both shown in age(P=0.002)and gender(P=0.002)between intrahepatic biliary cystadenocarcinoma and cystadenoma.There were no significant differences in symptom,symptom duration,CA199 and CEA.In the cystadenocarcinoma group,the lesions of 14 cases located only in the left lobe of the liver,while 16 cases in the cystadenoma group(P=0.115).The maximum diameter of the tumors were(7.38±3.98)cm and(10.21±7.82)cm(P=0.293),respectively.5(5/11)cystadenocarcinoma patients were combined with with introhepatic biliary dilatation nearby the lesions,while only 1 cystadenoma patient(1/21)(P=0.011)had the feature.Other imaging characteristics had no statistically significances.Conclusions Older age and male gender are associated with higher possibility of biliary cystadenocarcinoma.Intra-hepatic bile duct dilation near the lesion by radiology might be instrumental.CA19-9,CEA,clinical manifestations,and other imaging features are not of value for the differential diagnosis of cystadenocarcinoma and cystadenoma.