CAJ | 학술논문

目的总结原发性肝内胆管结石合并胆管癌的临床特征、诊断方法、治疗手段及预后.方法回顾性分析北京大学第三医院1958年6月至2011年3月收治的原发性肝内胆管结石合并胆管癌709例的临床资料.结果 709例原发性肝内胆管结石合并胆管癌20例(2.8％),获得随访17例,随访率为85％,中位随访时间2(0 ～15)年.胆管癌诊断前原发性肝内胆管结石病程15±11年(3 ～38年).有胆管炎的14例,其中重症胆管炎11例.合并肝脓肿12例,肝硬化或门静脉高压症15例.术前辅助检查提示合并胆管癌诊断的依次为CT、MRCP、B超、肿瘤标志物等.胆管癌的术前临床诊断率为55％ (11/20).行胆管癌根治术4例,姑息性手术7例,探查活检术6例,非手术治疗3例.根治术后1例失访,其余3例均存活,目前存活时间分别为1年1例,5年2例.姑息性手术7例,术后失访2例,存活时间1年2例,3年1例,5年1例.未切除者存活时间均未超过1年.结论对于原发性肝内胆管结石病例有以下情况者应提高警惕,(1)病史较长、有胆管炎.(2)合并肝硬化.(3)影像学提示胆管壁增厚或肝内占位病变.(4)肿瘤标志物升高.这些提示发生胆管癌的可能性大.对这些病例应严格定期随访,以便早期发现,获得根治切除者预后较好.
목적 총결원발성간내담관결석합병담관암적림상특정、진단방법、치료수단급예후.방법 회고성분석북경대학제삼의원1958년6월지2011년3월수치적원발성간내담관결석합병담관암709례적림상자료.결과 709례원발성간내담관결석합병담관암20례(2.8％),획득수방17례,수방솔위85％,중위수방시간2(0 ～15)년.담관암진단전원발성간내담관결석병정15±11년(3 ～38년).유담관염적14례,기중중증담관염11례.합병간농종12례,간경화혹문정맥고압증15례.술전보조검사제시합병담관암진단적의차위CT、MRCP、B초、종류표지물등.담관암적술전림상진단솔위55％ (11/20).행담관암근치술4례,고식성수술7례,탐사활검술6례,비수술치료3례.근치술후1례실방,기여3례균존활,목전존활시간분별위1년1례,5년2례.고식성수술7례,술후실방2례,존활시간1년2례,3년1례,5년1례.미절제자존활시간균미초과1년.결론 대우원발성간내담관결석병례유이하정황자응제고경척,(1)병사교장、유담관염.(2)합병간경화.(3)영상학제시담관벽증후혹간내점위병변.(4)종류표지물승고.저사제시발생담관암적가능성대.대저사병례응엄격정기수방,이편조기발현,획득근치절제자예후교호.
Objective To summarize the clinical features,diagnosis,treatment and prognosis of hepatolithiasis complicating cholangiocarcinoma. Methods From June 1958 to March 2011,709 cases of hepatolithiasis were admitted to Department of General Surgery,Peking University Third Hospital.The cases concomitant with cholangiocarcinoma were reviewed. Results 20 of 709 (2.8％ ) hepatolithiasis cases developed cholangiocarcinoma.17 cases (85％,17/20) were followed-up for 2 years (0 - 15 years).The hepatolithiasis course before the malignant diagnosis was 15 ± 1 1 years (3 -38 years).14 cases had frequent episodes of cholangitis,15 cases had liver cirrhosis.Preoperative diagnosis was established by CT,MRCP,B-ultrasound and tumor markers in 55％ (11/20) cases.4 cases underwent radical resection,7 received palliative resection,9 cases received conservative treatment.In radical resection,one lost to follow-up,one survived one year,two for 5 years.In palliative resection,2 lost to follow-up,two survived one year,one survived 3 years, one for 5 years. None in conservative group survived more than one year.Conclusions Cholangiocarcinoma developed from hepatolithiasis with a long history,frequent cholangitis,liver cirrhosis,especially in cases with imige showing thickness of bile duct or mass and rising tumor markers (CA19-9,CA125,CEA).The cases undergoing radical resection may have a favorable prognosis.