冰冻病理诊断在肝门部胆管癌根治术中的应用

Intraoperative frozen pathological diagnosis in radical resection of hilar cholangiocarcinoma

目的分析术中冰冻病理诊断在肝门部胆管癌根治术中的应用效果。方法回顾2011年1月至2017年12月在北京朝阳医院肝胆外科行手术治疗的49例肝门部胆管癌患者的临床资料,将术中冰冻病理诊断与术后病理诊断结果进行比较,分析术中冰冻病理诊断对肝门部胆管癌手术方案的影响以及患者预后情况。结果49例肝门部胆管癌患者均行术中冰冻病理检查;5例患者因冰冻结果与术前影像学结果不符,调整手术方案;47例术中冰冻结果与术后病理诊断结果相符,2例被误诊,准确率95. 9%,灵敏度90%,特异度97. 4%,假阳性率2. 6%,假阴性率10%。术中冰冻切缘阴性患者生存期明显优于切缘阳性患者(PvO.05)。结论肝门部胆管癌术中冰冻病理检査可指导手术方案,病理结果有助于提高肝门部胆管癌根治术的R0切除率,改善患者预后。

Objective To evaluate rapid frozen pathology in the operation of hilar cholangiocarcinoma. Methods Clinical data of 49 patients of hilar cholangiocarcinoma undergoing surgical treatment were analyzed retrospectively from Jan 2011 to Dec 2017 at Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University to evaluate rapid frozen pathology on operative strategy of hilar cholangiocarcinoma and the prognosis of patients. Results All patients with hilar cholangiocarcinoma underwent intraoperative frozen pathological examination. 5 patients adjusted the operation approach because of the discrepancy between frozen pathological examination and preoperative imaging results. 47 intraoperative frozen pathological results were consistent with postoperative pathological diagnosis, and the accuracy rate was 95. 9%, sensitivity 90%, specificity 97. 4%, false positive rate 2. 6%, false negative rate 10%. Frozen section margin negative patients had significantly longer survival time( P < 0. 05 ). Conclusions Intraoperative frozen pathological examination can guide the operation approach, greatly improve the resection rate of R0 and the prognosis of patients.