CAJ | 학술논문

目的分析肝内胆管囊腺癌的临床特点及治疗,探讨影响预后的相关因素.方法回顾性分析2002年1月至2007年9月共17例经手术病理证实为肝内胆管囊腺癌的临床资料,并进行随访.对预后的影响采用Cox回归分析和Kaplan-Meier分析.结果 17例中男4例,女13例,平均年龄为49.3岁.患者以上腹痛为主要临床表现,仅2例患者CA19-9异常,2例CEA异常,17例患者AFP均正常.17例中行根治性手术7例,肿瘤完全切除联合取瘤栓术7例,姑息性手术3例.病理提示胆管囊腺癌10例,胆管囊腺瘤局部癌变2例,乳头状胆管囊腺癌2例,黏液性乳头状胆管囊腺癌2例;1例为肝内胆管囊腺癌与肝细胞癌双结节混合性癌.17例中肿瘤高分化7例,中分化3例,低分化7例.手术方式(β=-0.692,P=0.01)、肿瘤分化程度(β=-2.041,P=0.007)对预后影响有统计学意义.结论肝内胆管囊腺癌以成年女性多见.血清CA19-9对诊断无帮助.肝内胆管囊腺癌的胆总管癌栓并不预示临床预后差,行根治性手术或根治性切除联合取栓术均能有较好的预后.
목적 분석간내담관낭선암적림상특점급치료,탐토영향예후적상관인소.방법 회고성분석2002년1월지2007년9월공17례경수술병리증실위간내담관낭선암적림상자료,병진행수방.대예후적영향채용Cox회귀분석화Kaplan-Meier분석.결과 17례중남4례,녀13례,평균년령위49.3세.환자이상복통위주요림상표현,부2례환자CA19-9이상,2례CEA이상,17례환자AFP균정상.17례중행근치성수술7례,종류완전절제연합취류전술7례,고식성수술3례.병리제시담관낭선암10례,담관낭선류국부암변2례,유두상담관낭선암2례,점액성유두상담관낭선암2례;1례위간내담관낭선암여간세포암쌍결절혼합성암.17례중종류고분화7례,중분화3례,저분화7례.수술방식(β=-0.692,P=0.01)、종류분화정도(β=-2.041,P=0.007)대예후영향유통계학의의.결론 간내담관낭선암이성년녀성다견.혈청CA19-9대진단무방조.간내담관낭선암적담총관암전병불예시림상예후차,행근치성수술혹근치성절제연합취전술균능유교호적예후.
Objective To explore the clinical features, treatment and prognosis of intrabepatic biliary cystadenocarcinoma (IBC). Methods We retrospectively analyzed clinical data of 17 patients with pathologically confirmed IBC, treated between January 2002 and September 2007. Results Of the 17 patients, 4 were men and 13 were women, with a mean age of 49.3 years (range 45 -68). Serum level of AFP was normal in all patients. CA19-9 was abnormally elevated in only two patients and the other two had abnormal serum level of CEA. Seven cases underwent radical resection, 7 underwent complete tumor resection combined with removal of tumor thrombi in the bile duct, 3 received palliative surgery. On histopathological examination, 10 were biliary cystadenocarcinoma,2 were biliary cystadenoma with partial eanceration,2 were papillary cystadenocarcinoma,2 were mutinous papillary cystadenocarcinoma and 1 was of mixed cystadenocarcinoma and hepatocellular carcinoma. According to tumor differentiation, the number of well, moderate and poor-differentiated group was 7, 3 and 7 cases respectively. The medality of surgery (β= - 0.692, P = 0.01) and tumor differentiation (β = - 2.041, P = 0.007) effected the prognosis significantly. Conclusions IBC occurs mainly in elderly women. CA19-9 examination does not help in the establishment of diagnosis of IBC. The occurrence of tumor thrombosis in common bile duct doesn't necessarily indicate poor prognosis, hence a IBC patient will still have a satisfactory prognosis should the primary tumor be completely resected and tumor thrombi removed.