Removal of intrahepatic bile duct stone could reduce the risk of cholangiocarcinoma: A single-center retrospective study in South Korea

BACKGROUND Intrahepatic duct(IHD)stones are among the most important risk factors for cholangiocarcinoma(CCC).Approximately 10%of patients with IHD stones develop CCC;however,there are limited studies regarding the effect of IHD stone removal on CCC development.AIM To investigate the association between IHD stone removal and CCC development.METHODS We retrospectively analyzed 397 patients with IHD stones at a tertiary referral center between January 2011 and December 2020.RESULTS CCC occurred in 36 of the 397 enrolled patients.In univariate analysis,chronic hepatitis B infection(11.1%vs 3.0%,P=0.03),carbohydrate antigen 19-9(CA19-9,176.00 vs 11.96 II/mL,P=0.010),stone located in left or both lobes(86.1%vs 70.1%,P=0.042),focal atrophy(52.8%vs 26.9%,P=0.001),duct stricture(47.2%vs 24.9%,P=0.004),and removal status of IHD stone(33.3%vs 63.2%,P<0.001)were significantly different between IHD stone patients with and without CCC.In the multivariate analysis,CA19-9>upper normal limit,carcinoembryonic antigen>upper normal limit,stones located in the left or both lobes,focal atrophy,and complete removal of IHD stones without recurrence were independent factors influencing CCC development.However,the type of removal method was not associated with CCC risk.CONCLUSION Complete removal of IHD stones without recurrence could reduce CCC risk.

Congenital left intrahepatic bile duct draining into gastric wall mimicking biliary reflux gastritis

Abnormalities and variations of the biliary ducts are not rare.Most aberrant bile ducts eventually drain into the descending part of duodenum through the papilla of vater.However,drainage of the left hepatic bile duct into the stomach is extremely rare.A 29-year old man was admitted to the hospital with the diagnosis of biliary reflux gastritis.Comprehensive imaging modalities were performed including electronic endoscopy,endoscopic ultrasonography,endoscopic retrograde cholangiopancreatography and magnetic resonance cholangio-pancreatography.Finally,congenital ectopic left intrahepatic bile duct draining into the stomach was found,which caused biliary reflux gastritis.The patient did not receive any surgery.Good recovery was achieved by medical treatment.

A case of very large intrahepatic bile duct adenoma followed for 7 years

A 70-year-old man was referred to our hospital due to abnormal liver function. A tumor of 92 mm × 61 mm was detected on ultrasound screening of the left liver lobe. Although the tumor was suspected to be intrahepatic bile duct carcinoma, he had chronic heart disease and was unable to undergo surgery. Therefore, he was followed without further testing. No increase in tumor serum markers or tumor size was observed for the subsequent 7 years. We continued to suspect intrahepatic bile duct carcinoma, and we decided to perform a tumor biopsy. Tumor biopsy findings indicated intrahepatic bile duct adenoma(BDA), which is a rare benign epithelial liver tumor typically ranging from 1 mm to20 mm. We herein report a case of very large BDA followed for 7 years.

Modified rendezvous intrahepatic bile duct cannulation technique to pass a PTBD catheter in ERCP

The rendezvous procedure combines an endoscopic technique with percutaneous transhepatic biliary drainage(PTBD).When a selective common bile duct cannulation fails,PTBD allows successful drainage and retrograde access for subsequent rendezvous techniques.Traditionally,rendezvous procedures such as the PTBDassisted over-the-wire cannulation method,or the parallel cannulation technique,may be available when a bile duct cannot be selectively cannulated.When selective intrahepatic bile duct(IHD) cannulation fails,this modified rendezvous technique may be a feasible alternative.We report the case of a modified rendezvous technique,in which the guidewire was retrogradely passed into the IHD through the C2 catheter after end-to-end contact between the tips of the sphincterotome and the C2 catheter at the ampulla's orifice,in a 39-year-old man who had been diagnosed with gallbladder carcinoma with a metastatic right IHD obstruction.Clinically this procedure may be a feasible and timesaving technique.

Clinical Studies on Ultrasound Lithotripsy in Intrahepatic Bile－duct via Abdomen

patients with left/right intrahepatic bile-duct calculi received ultrasonic lithotresis via abdomen by using the percutaneous cholecystoscopeand ultrasonic lithotresis apparatus. The results indicated that all the surgical manipulations were successful with a residual rate of 6. 7 %, compared with a residual rate of 78. 2 % in 23 cases of left/right intrahepatic bile-duct lithiasis treated simultaneously by lithotomy apparatus. The differences between them were statistically significant (μ= 4. 29, P<0. 01). Among 12 cases undergoing follow-up observation , no side effect due to ultrasonic lithotresis and no residual calculus after 2- 4 check-ups with B-mode ultrasound diagnostic set were found and all of their symptoms disappeared except for 1 case.

The abnormal expression of E-cadherin in intrahepatic bile duct epithelia cells in biliary atresia and its relationship with apoptosis

To explore the relationship between the expression of E-cadherin and the apoptosis in intrahepatic bile duct epithelial cells in biliary atresia (BA).Methods The E-cadherin expression was demonstrated by immunohistochemical staining for the liver specimens from 38 children with BA and 16 normal children.The apoptotic intrahepatic bile duct epithelial cells in these specimens were visualized by TdT-mediated dUTP-digoxigenin nick end labeling (TUNEL) assay,and the apoptotic index (AI) was calculated from the percentage of apoptotic cells in total cells.Results The intensity of E-cadherin expression in bile duct epithelial cells in BA group was lower than that in the normal control group (0.33±0.12 vs 0.62±0.20,P<0.01).On the other hand,the AI in BA group was significant higher than that in control group (51.74±19.93 vs 12.34±19.32,P<0.01).An inverse correlation was detected between the intensity of E-cadherin and the AI in the liver from children with BA.Conclusion The abnormal decrease of E-cadherin may lead to an increase of the apoptosis of intrahepatic bile epithelial cells in BA,resulting in developmental disorder of intrahepatic bile duct and ductal plate malformation in the liver.12 refs,4 figs,1 tab.

Pathological classification of intrahepatic cholangiocarcinoma based on a new concept

Intrahepatic cholangiocarcinoma (ICC) arises from the lining epithelium and peribiliary glands of the intrahepatic biliary tree and shows variable cholangiocytic dif-f-e-re-ntiation. To date-,ICC was large-ly classifie-d into adenocarcinoma and rare variants. Herein,we propose to subclassify the former,based on recent progress in the-study of-ICC including the-gross classification and hepatic progenitor/stem cells and on the pathological similarities between biliary and pancreatic neoplasms. That is,ICC is classifiable into the conventional (bile duct) type,the bile ductular type,the intraductal neoplasm type and rare variants. The conventional type is further divided into the small duct type (peripheral type) and large bile duct type (perihilar type). The former is a tubular or micropapillary adenocarcinoma while the latter involves the intrahepatic large bile duct. Bile ductular type resembles proliferated bile ductules and shows a replacing growth of the hepatic parenchyma.Hepatic progenitor cell or stem cell phenotypes such as neural cell adhesion molecule expression are frequently expressed in the bile ductular type. Intraductal type includes papillary and tubular neoplasms of the bile duct (IPNBs and ITNBs) and a superficial spreading type. IPNB and ITNB show a spectrum from a preneoplastic borderline lesion to carcinoma and may have pancreatic counterparts. At invasive sites,IPNB is associated with the conventional bile duct ICC and mucinous carcinoma. Biliary mucinous cystic neoplasm with ovarian-like stroma in its wall is different from IPNB,particularly IPNB showing cystic dilatation of the affected ducts. Rare variants of ICC include squamous/adenosquamous cell carcinoma,mucinous/signet ring cell carcinoma,clear cell type,undifferentiated type,neuroendocrine carcinoma and so on. This classification of-ICC may ope-n up a ne-w fie-ld of-re-se-arch of-ICC and contribute-to the-clini cal approach to ICC.

Apoptosis and proliferation of intrahepatic bil educt after ischemia-reperfusion injury

BACKGROUND: In orthotopic liver transplantation, ische-mic-reperfusion is one of the most important factors thatcause the incidence of biliary complicance. The aim of thisstudy was to investigate the effects of ischemia reperfusionon epithelial cells apoptosis and proliferation of intrahepaticbile duct (IBD) (>20 μm).METHODS: 30-minute warm ischemia was applied to ratlivers respectively, and experiment was performed on days2,7, 14, 28 after reperfusion. Apoptosis was determined insitu by morphology and TUNEL, and cholangiocyte proli-feration was evaluated in situ by morphometry of liver sec-tions stained for cytokeratin-19 ( CK-19) and by prolifera-ting cellular nuclear antigen staining in liver sections.RESULTS: Two days after ischemia reperfusion, apoptosisof cells was observed in large intrahepatic bile ducts (>20μm) (5.6%±1.2%) , but the number of large intrahepaticbile ducts reduced (0.32 ±0.06). Seven days after ischemiareperfusion, the apoptosis index of cholangiocytes de-creased to 1.2%±0.3%, and the number of intrahepatic bileducts began to proliferate and returned to nearly normal onday 28.CONCLUSION: Ischemia reperfusion causes a decrease inthe number of intrahepatic bile ducts (>20 μm) as a resultof a higher rate of apoptosis and absence of initial prolifera-tion.

Clinical and biological significance of precursor lesions of intrahepatic cholangiocarcinoma

Cholangiocarcinoma(CC) is primarily a malignant tumor of older adults most prevalent in Southeast Asia,where liver fluke infestation is high.However the etiology in western countries is unknown.Although the incidence of extrahepatic cholangiocarcinoma has remained constant,incidence of intrahepatic CC(ICC) which differs inmorphology,pathogenesis,risk factors,treatment and prognosis is increasing.While this increase is associated with hepatitis C virus infection,chronic nonalcoholic liver disease,obesity,and smoking,the pathogenesis of ICC and molecular alterations underlying the carcinogenesis are not completely elucidated.Benign biliary lesions such as biliary intraepithelial neoplasia,intraductal papillary neoplasm of the bile duct,von Meyenburg complex or bile duct hamartoma,and bile duct adenoma have been associated with ICC.For each of these entities,evidence suggests or supports a role as premalignant lesions.This article summarized the important biological significance of the precursor lesions of ICC and the molecular mechanisms that may be involved in intrahepatic cholangiocarcinogenesis.

Preventive effects of autologous bone marrow mononuclear cell implantation on intrahepatic ischemic-type biliary lesion in rabbits

BACKGROUND: The ischemic-type biliary lesion (ITBL) is one of the most serious biliary complications of liver transplantation. This study aimed to investigate the effects of autologous bone marrow mononuclear cell (BM-MNC) implantation on neovascularization and the prevention of intrahepatic ITBL in a rabbit model. METHODS: The rabbits were divided into control, experimental model, and cell implantation groups, with 10 in each group. The model of intrahepatic ITBL was established by clamping the hepatic artery and common bile duct. Autologous BM-MNCs were isolated from the tibial plateau by density gradient centrifugation and were implanted through the common hepatic artery. Changes in such biochemical markers as aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyltranspeptidase, total bilirubin and direct bilirubin were measured. Four weeks after operation, cholangiography, histopathological manifestations, differentiation of BM-MNCs, microvessel density and the expression of vascular endothelial growth factor were assessed. RESULTS: Compared with the experimental model group, the BM-MNC implantation group showed superiority in the time to recover normal biochemistry. The microvessel density and vascular endothelial growth factor expression of the implantation group were significantly higher than those of the control and experimental model groups. The ITBL in the experimental model group was more severe than that in the implantation group and fewer new capillary blood vessels occurred around it. CONCLUSIONS: Implanted autologous BM-MNCs can differentiate into vascular endothelial cells, promote neovascularization and improve the blood supply to the ischemic bile duct, and this provides a new way to diminish or prevent intrahepatic ITBL after liver transplantation. (Hepatobiliary Pancreat Dis Int 2010; 9:593-599)

Clinical characteristics of intrahepatic biliary papilloma:A case report

BACKGROUND Intrahepatic bile duct papilloma(IPNB)is a rare benign tumour from the bile duct epithelium and has a high malignant transformation rate.Early radical resection can obviously improve the prognosis of patients,but it is difficult to be sure of the diagnosis of IPNB before operating.CASE SUMMARY This study included 28 patients with intraductal papilloma admitted to the First Hospital of Jilin University from January 2010 to November 2020 and recorded their clinical manifestations,imaging features,complications and prognosis.There were 12 males and 16 females with an average age of 61.36±8.03 years.Most patients had symptoms of biliary obstruction.Biliary dilatation and cystic mass could be seen on imaging.After surgery,IPNB was diagnosed by pathology.CONCLUSION IPNB is a rare benign tumour in the bile duct.Early diagnosis and timely R0 resection can improve the prognosis of IPNB.

Cystic Degeneration of Peripheral Intrahepatic Cholangiocarcinoma: An Atypical Presentation

Cholangiocarcinomas are primary malignant tumors of the liver that arises from the epithelium lining the small intra and extrahepatic bile ducts, and has numerous histologic types and growth patterns. At computed tomography (CT) and magnetic ressonance (MR), it has various appearences which motivated the present study;we present a case within an atypical presentation. The objective is to show the variety of differential diagnoses before an atypical aspect and the importance of the imaging methods for the diagnosis. Cholangiocarcinoma is still an uncommon neoplasm, and CT and MR are crucial for accurate diagnosis and for differentiation from other hepatic tumorous and nontumorous lesions.

腹腔镜联合胆道镜治疗左肝内胆管结石合并胆总管结石的安全性及有效性分析

目的:研究腹腔镜联合胆道镜治疗左肝内胆管结石同时合并胆总管结石的效果,同时探讨安全性及有效性。方法:选取萍乡市人民医院肝胆胰外科2018年1月—2022年12月收治的左肝内胆管结石合并胆总管结石患者180例作为研究对象,按照随机数字表法分为观察组(90例)和对照组(90例)。观察组的患者使用腹腔镜左肝切除及胆道镜取石,对照组的患者采取常规开腹左肝切除及胆道镜取石,比较两组患者相关手术时间、术中出血量、术后患者结石残留率、并发症发生率,比较两组患者术后下地时间、胃肠道功能恢复时间、术后住院时间及肝功能变化等指标。结果:观察组的手术时间长于对照组,其术中出血量少于对照组,术后下地时间、术后胃肠道功能恢复时间、术后住院时间均明显短于对照组(P<0.05)。观察组术后丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)和总胆红素(TBIL)的水平均明显低于对照组(P<0.05)。观察组围手术期切口感染、胆漏、胆道出血及肺部感染的发生率为6.67%(6/90),显著低于对照组的16.67%(15/90)(P<0.05)。术后随访显示,观察组结石残留率为3.33%(3/90),对照组为2.22%(2/90),两组间结石残留率差异无统计学意义(P>0.05)。结论:腹腔镜肝切除联合胆道镜取石治疗左肝内胆管结石合并胆总管结石可减少手术创伤,加快患者康复,改善肝功能,减少术后并发症,取石效果好,安全可靠。

鞘管保护下硬质胆道镜经腹腔镜胆总管入路治疗肝内外胆管结石的临床价值

目的探讨鞘管保护下硬质胆道镜(硬镜)经腹腔镜胆总管入路治疗肝内胆管结石和胆总管结石的临床价值。方法选取115例肝内外胆管结石患者作为研究对象。根据手术方法将患者分为硬镜组58例、软镜组57例,硬镜组采用鞘管保护下硬质胆道镜经腹腔镜胆总管入路取石治疗,软镜组采用纤维胆道镜经腹腔镜胆总管入路取石治疗。比较两组患者的手术时间、术中出血量、术后住院时间、结石清除率,以及术后第1天肝功能(空腹静脉血总胆红素、直接胆红素、碱性磷酸酶、γ-谷氨酰转移酶水平)、术后并发症发生情况等。结果硬镜组患者的手术时间短于软镜组,结石清除率高于软镜组,差异均有统计学意义(均P<0.05);两组患者的术中出血量、术后住院时间、术后并发症发生率,以及术后第1天总胆红素、直接胆红素、碱性磷酸酶、γ-谷氨酰转移酶水平比较,差异均无统计学意义(均P>0.05)。结论鞘管保护下硬质胆道镜经腹腔镜胆总管入路治疗肝内胆管结石和胆总管结石的手术时间短、结石清除率高,是一种安全、高效的手术策略,具有一定的潜在应用价值。

Servqual模型评价肝内外胆管结石微创手术护理质量的研究

目的探究Servqual模型在评价肝内外胆管结石微创手术护理质量中的应用效果。方法选取2021年1月至2022年6月于九江市第一人民医院肝胆外科行肝内外胆管结石微创手术的200例住院患者作为研究对象,采用随机数字表法分为对照组与观察组,每组100例。对照组给予常规护理,观察组给予改进护理干预。两组均采用Servqual量表评估护理质量。比较两组护理质量评分,采用单因素分析和多元线性回归分析护理质量的影响因素。结果观察组移情性、保证性、反应性、可靠性、有形性及总分服务期望(E)、服务感知(P)、感知服务质量(SQ)值均高于对照组,差异有统计学意义(P<0.05);单因素分析结果显示,不同学历、家庭人均月收入、医疗支付方式、不良情绪、自理能力、病房环境、护理人员态度的患者SQ值比较差异有统计学意义(P<0.05)。多元线性回归分析结果显示,家庭人均月收入、医疗支付方式是护理质量的影响因素(P<0.05)。结论Servqual模型评价肝内外胆管结石微创手术的护理质量具有可靠性,可有效评估护理干预中存在的问题,并提出相应改进对策,提升护理质量。

腹腔镜解剖性肝Ⅲ段切除治疗左肝区域性肝内胆管结石临床效果

目的 探讨腹腔镜解剖性肝Ⅲ段切除治疗左肝区域性肝内胆管结石的手术要点、适应证及可行性。方法 采用回顾性描述性研究方法,收集2021年8月至2022年10月湘雅常德医院(3例)和湘西土家族苗族自治州人民医院(1例)收治的4例局限于肝Ⅲ段的肝内胆管结石患者临床资料,其中男1例,女3例,中位年龄61.5(45.0~69.0)岁。4例患者中,2例为单纯性肝Ⅲ段肝内胆管结石,1例为肝Ⅲ段肝内胆管结石合并胆囊结石、胆总管结石,1例为肝Ⅲ段肝内胆管结石合并胆囊结石。4例患者均接受腹腔镜解剖性肝Ⅲ段切除术式治疗局限于肝Ⅲ段的肝内胆管结石。结果 4例患者均顺利完成腹腔镜解剖性肝Ⅲ段切除术,其中1例实施联合肝左静脉重建的解剖性肝Ⅲ段切除术。无中转开腹病例及切肝范围的变更。手术时间分别为280 min、440 min、220 min及110 min;第一肝门阻断时间分别为60 min、60 min、75 min和25 min。术中均无输血。4例患者术后住院时间分别为12 d、10 d、9 d和6 d。1例发生肝断面积液,经保守治疗吸收治愈;其余3例均无并发症发生。4例患者均获随访,中位随访时间19.5(10.0~24.0)个月,均无结石复发或胆道相关症状。结论 对于符合特定解剖条件的局限于肝Ⅲ段的肝内胆管结石,腹腔镜解剖性肝Ⅲ段切除术安全可行,疗效满意。

肝内胆管结石影响肝内胆管癌患者手术预后的回顾性分析

目的探讨肝内胆管结石(IBDS)对接受根治性手术的肝内胆管细胞癌(ICC)患者的预后影响。方法回顾性分析2010年1月至2022年9月浙江省肿瘤医院收治的204例完成根治性手术的ICC患者的临床资料,根据患者有无IBDS,分为IBDS阴性组(n=179)和IBDS阳性组(n=25),采用Kaplan-Meier法绘制生存曲线并计算累积存活率,Log-rank检验及Cox回归模型评估影响手术预后的因素。结果与IBDS阳性组比较,IBDS阴性组患者1、3、5年生存率分别为73.8%vs 40.0%、52.0%vs 26.7%、34.9%vs 0,中位生存期(OS)为20.2个月vs 10.0个月,1、3、5年的无复发生存率为54.0%vs 20.0%、30.2%vs 15.0%、25.7%vs 0,中位无复发生存期(RFS)为13.1个月vs 7.6个月,差异均有统计学意义(P<0.01)。IBDS阳性组二次分组的生存曲线分析表明,淋巴结转移严重影响IBDS阳性组ICC患者术后的OS(P=0.012),降低了IBDS阳性组ICC患者术后的RFS(P=0.004)。结论IBDS明显降低ICC患者根治性手术的远期效果,淋巴结转移则严重影响IBDS阳性ICC患者的预后;注重IBDS的治疗以及淋巴结转移的预防可能改善ICC患者手术预后。

不同剂量瑞马唑仑对肝内外胆管结石手术患者麻醉效果及血流动力学影响

目的:探讨不同剂量瑞马唑仑对肝内外胆管结石手术患者麻醉效果及血流动力学的影响。方法:选取103例行肝内外胆管结石手术的患者为研究对象,采用瑞马唑仑麻醉,根据麻醉剂量不同分为低剂量组(0.2 mg/kg,n=52)及高剂量组(0.3 mg/kg,n=51)。比较两组患者麻醉效果、镇痛效果、氧化应激程度、血流动力学及不良反应发生情况。结果:低剂量组拔管时间及苏醒时间均短于高剂量组(P<0.05)。麻醉后,两组患者Ramsay评分均随时间发展而逐渐升高,且低剂量组Ramsay评分在麻醉15 min及麻醉30 min时均低于高剂量组(P<0.05)。术后6、12、24 h,高剂量组VAS评分均低于低剂量组,且两组患者VAS评分均随时间发展呈先升高后下降趋势(P<0.05)。术后1 d,两组患者过氧化氢(H_(2)O_(2))、人皮质醇(Cor)及丙二醛(MDA)水平均高于术前,且低剂量组各指标水平均低于高剂量组(P<0.05)。麻醉后15 min,两组患者舒张压、收缩压及心率水平均升高,高剂量组血氧饱和度降低,且低剂量组舒张压、收缩压及心率低于高剂量组,血氧饱和度高于高剂量组(P<0.05)。两组患者不良反应发生率无统计学差异(P>0.05)。结论:两种剂量瑞马唑仑麻醉均具有较高的麻醉、镇静及镇痛效果,但高剂量麻醉易导致患者血流动力学波动较大,易引起患者产生较大应激反应,因此对于肝内外胆管结石手术采用低剂量麻醉安全性更佳。

自制纱布条在降低腹腔镜胆总管探查术治疗肝内胆管结石术后残石率中的应用效果

目的探讨自制纱布条在降低腹腔镜胆总管探查术(LCBDE)治疗肝内胆管结石术后残石率的应用效果。方法选取2020年7月至2023年1月上饶市中心医院普外科收治的40例经计算机断层扫描(CT)、磁共振成像(MRI)、磁共振胰胆管造影(MRCP)确诊为胆总管结石合并肝内胆管多发结石的患者作为研究对象,采用随机数字表法将其分为塞纱布条组和不塞纱布条组,每组各20例。两组患者均进行LCBDE手术治疗,塞纱布条组患者在胆总管结石取干净后,准备进行胆道镜探查治疗肝内胆管结石前,采用自制纱布条对胆总管下段进行填塞,不塞纱布条组则不采用纱布条填塞。比较两组患者治疗情况(手术时间、术后排气时间、经T管胆道镜下碎石取石次数、住院时间);比较术前、术后3 d时两组患者肠道屏障功能水平(D-乳酸、内毒素);比较两组患者术后6个月复查时残石率。结果塞纱布条组手术时间、术后排气时间、住院时间短于不塞纱布条组,经T管胆道镜下碎石取石次数少于不塞纱布条组,差异有统计学意义(P<0.05)。术后3 d,两组患者D-乳酸、内毒素水平高于本组术前,塞纱布条组D-乳酸、内毒素水平低于不塞纱布条组,差异有统计学意义(P<0.05)。术后6个月复查时,塞纱布条组患者残石率低于不塞纱布条组,差异有统计学意义(P<0.05)。结论自制纱布条用于LCBDE治疗肝内胆管结石术中,可有效缩短手术时间,促进患者术后胃肠功能恢复,并有效降低术后的残石率,值得临床推广应用。

彩超联合CA199诊断肝内胆管结石合并肝内胆管细胞癌的价值

目的分析在诊断肝内胆管结石合并肝内胆管细胞癌时采取彩超联合CA199诊断方式的应用价值。方法抽取2017年7月—2022年12月我院肝胆胰外科收治的患者180例做为研究对象,并对其临床资料进行回顾性分析。以病理诊断结果为金标准进行分组,对照组共计150例,均为单纯肝内胆管结石患者,观察组共计30例,为肝内胆管结石合并肝内胆管细胞癌患者。所有患者均接受彩超检查、CA199检测,分析彩超联合CA199诊断肝内胆管结石合并肝内胆管细胞癌的诊断价值。结果对两组患者一般资料进行分析可见,观察组患者中男性占比高于对照组、有上腹部疼痛及高热症状的患者占比均低于对照组(均P<0.05);两组患者梗阻性黄疸、体重减轻、腹水、肝区叩痛以及肝外淋巴结肿大患者占比对比均无差异(均P>0.05)。彩超联合CA199诊断的准确度及特异度均高于单独应用彩超或单独应用CA199诊断(均P<0.05);彩超联合CA199诊断的敏感度与单独应用彩超或CA199诊断的敏感度对比均无差异(均P>0.05)。结论肝内胆管结石合并肝内胆管细胞癌诊断难度较高,易被误诊或漏诊,采取彩超联合CA199诊断的方式可显著提升诊断准确性,可为临床进行诊治提供较为可靠的依据。