实用癌症杂志
實用癌癥雜誌
실용암증잡지
THE PRACTICAL JOURNAL OF CANCER
2014年
3期
298-300
,共3页
肝内胆管结石%肝内胆管癌%肝切除术%临床特征%预后
肝內膽管結石%肝內膽管癌%肝切除術%臨床特徵%預後
간내담관결석%간내담관암%간절제술%림상특정%예후
Hepatolithiasis%Intrahepatic cholangiocarcinoma%Hepatectomy%Clinical characteristics%Prognosis
目的：探讨长期肝内胆管结石患者发生肝胆管癌变的临床特征、治疗效果及长期预后情况。方法选择肝内胆管结石患者共498例，其中经过术前腹部彩超、CT或MRI、内镜逆行胰胆管造影或经皮经肝胆管造影及术中手术切除病理显示为肝胆管癌变者37例（7．4％），观察其临床特征、治疗效果及预后随访。结果①肝内胆管结石并胆管癌变组较单纯肝内胆管结石组患者的年龄大[（55．2±13．6）VS．（35．2±17．4），P＝0．032]，临床症状如右上腹隐痛、畏寒、发热、恶心、呕吐及皮肤、巩膜黄染病史较多（62．2％VS．24．3％，P＝0．042），结石病程较长[（9．4±4．1）VS．（5．8±3．2）年，P＝0．047]，既往有胆道手术史较长（56．7％VS．18．0％，P＜0．01）；②与单纯肝内胆管结石组相比，肝内胆管结石并胆管癌变组患者术前检查的外周白细胞计数、总胆红素、谷丙转氨酶较高（59．5％VS．33．8％，P＝0．042），HBsAg（＋）及AFP（＋）例数较多（21．6％VS．12．8％，P＝0．045），彩超提示肝内占位性病变较多（18．9％VS．8．9％，P＜0．01）；③与单纯肝内胆管结石组相比，肝内胆管结石并胆管癌变组患者术中探查发现肝内占位病变直径＞5 cm的较多（73．0％ VS．19．1％，P＜0．01），行内镜下逆行胆汁内引流及内支架植入术者较少（13．5％VS．89．8％，P＜0．01），行开腹手术者较多（86．5％VS．10．2％，P＜0．01），行肝切除术者较多（48．6％ VS．0．4％，P＜0．01），围手术期死亡者较多（16．2％ VS．0．7％，P＜0．01），1、3、5年远期生存率均较低（P＜0．05）。结论临床中需要高度警惕长期肝内胆管结石发生胆管癌变的可能，详细了解患者的临床特征，定期复查。肝切除术是目前较为彻底的治疗肝内胆管结石合并癌变的1种有效的手术，可提高部分患者的长期生存率。
目的：探討長期肝內膽管結石患者髮生肝膽管癌變的臨床特徵、治療效果及長期預後情況。方法選擇肝內膽管結石患者共498例，其中經過術前腹部綵超、CT或MRI、內鏡逆行胰膽管造影或經皮經肝膽管造影及術中手術切除病理顯示為肝膽管癌變者37例（7．4％），觀察其臨床特徵、治療效果及預後隨訪。結果①肝內膽管結石併膽管癌變組較單純肝內膽管結石組患者的年齡大[（55．2±13．6）VS．（35．2±17．4），P＝0．032]，臨床癥狀如右上腹隱痛、畏寒、髮熱、噁心、嘔吐及皮膚、鞏膜黃染病史較多（62．2％VS．24．3％，P＝0．042），結石病程較長[（9．4±4．1）VS．（5．8±3．2）年，P＝0．047]，既往有膽道手術史較長（56．7％VS．18．0％，P＜0．01）；②與單純肝內膽管結石組相比，肝內膽管結石併膽管癌變組患者術前檢查的外週白細胞計數、總膽紅素、穀丙轉氨酶較高（59．5％VS．33．8％，P＝0．042），HBsAg（＋）及AFP（＋）例數較多（21．6％VS．12．8％，P＝0．045），綵超提示肝內佔位性病變較多（18．9％VS．8．9％，P＜0．01）；③與單純肝內膽管結石組相比，肝內膽管結石併膽管癌變組患者術中探查髮現肝內佔位病變直徑＞5 cm的較多（73．0％ VS．19．1％，P＜0．01），行內鏡下逆行膽汁內引流及內支架植入術者較少（13．5％VS．89．8％，P＜0．01），行開腹手術者較多（86．5％VS．10．2％，P＜0．01），行肝切除術者較多（48．6％ VS．0．4％，P＜0．01），圍手術期死亡者較多（16．2％ VS．0．7％，P＜0．01），1、3、5年遠期生存率均較低（P＜0．05）。結論臨床中需要高度警惕長期肝內膽管結石髮生膽管癌變的可能，詳細瞭解患者的臨床特徵，定期複查。肝切除術是目前較為徹底的治療肝內膽管結石閤併癌變的1種有效的手術，可提高部分患者的長期生存率。
목적：탐토장기간내담관결석환자발생간담관암변적림상특정、치료효과급장기예후정황。방법선택간내담관결석환자공498례，기중경과술전복부채초、CT혹MRI、내경역행이담관조영혹경피경간담관조영급술중수술절제병리현시위간담관암변자37례（7．4％），관찰기림상특정、치료효과급예후수방。결과①간내담관결석병담관암변조교단순간내담관결석조환자적년령대[（55．2±13．6）VS．（35．2±17．4），P＝0．032]，림상증상여우상복은통、외한、발열、악심、구토급피부、공막황염병사교다（62．2％VS．24．3％，P＝0．042），결석병정교장[（9．4±4．1）VS．（5．8±3．2）년，P＝0．047]，기왕유담도수술사교장（56．7％VS．18．0％，P＜0．01）；②여단순간내담관결석조상비，간내담관결석병담관암변조환자술전검사적외주백세포계수、총담홍소、곡병전안매교고（59．5％VS．33．8％，P＝0．042），HBsAg（＋）급AFP（＋）례수교다（21．6％VS．12．8％，P＝0．045），채초제시간내점위성병변교다（18．9％VS．8．9％，P＜0．01）；③여단순간내담관결석조상비，간내담관결석병담관암변조환자술중탐사발현간내점위병변직경＞5 cm적교다（73．0％ VS．19．1％，P＜0．01），행내경하역행담즙내인류급내지가식입술자교소（13．5％VS．89．8％，P＜0．01），행개복수술자교다（86．5％VS．10．2％，P＜0．01），행간절제술자교다（48．6％ VS．0．4％，P＜0．01），위수술기사망자교다（16．2％ VS．0．7％，P＜0．01），1、3、5년원기생존솔균교저（P＜0．05）。결론림상중수요고도경척장기간내담관결석발생담관암변적가능，상세료해환자적림상특정，정기복사。간절제술시목전교위철저적치료간내담관결석합병암변적1충유효적수술，가제고부분환자적장기생존솔。
Objective To analyse clinical features ,effect and long-term prognosis of hepatolithiasis patient with intrahe-patic cholangiocarcinoma .Methods 37 cases in 498 hepatolithiasis patients were confirmed to be intrahepatic cholangiocarcino-ma by abdominal ultrasonography ,CT or MRI,endoscopic retrograde cholangiopancreatography ( ERCP) or percutaneous transhe-patic cholangiography and intraoperative surgical resection pathology .Clinical manifestation,effect and follow-up were observed. Results Age in hepatolithiasis patients with intrahepatic cholangiocarcinoma group was larger than that of hepatolithiasis group [(55.2 ±13.6)VS.(35.2 ±17.4)ys,P=0.032],clinical manifestations mainly were right upper abdominal pain ,chilly,fever, nausea and jaundice (62.2%VS.24.3%,P=0.042),courses of biliary calculi[(9.4 ±4.1)VS.(5.8 ±3.2)ys,P=0.047] and biliary tract surgery were longer (56.7% VS.18.0%,P<0.01);Peripheral white blood cell count ,total bilirubin,alanine aminotransferase in hepatolithiasis with intrahepatic cholangiocarcinoma group were higher (59.5%VS.33.8%,P=0.042),pa-tients with HBsAg(+)and AFP(+) (21.6%VS.12.8%,P=0.045)and intrahepatic lesions were more (18.9%VS.8.9%, P<0.01);the diameter of intrahepatic lesions >5 cm in hepatolithiasis patients with intrahepatic cholangiocarcinoma group were more(73.0%VS.19.1%,P<0.01),patients who underwent endoscopic retrograde biliary drainage and stenting were less (13. 5%VS.89.8%,P<0.01),and who received laparotomy (86.5%VS.10.2%,P<0.01),anatomic hepatic resection (48.6%VS.0.4%,P<0.01) and died during the hospital stay were more (16.2% VS.0.7%,P<0.01),1-,3-,5-year long-term sur-vival rates were lower (P<0.05).Conclusion Long-term hepatolithiasis has the possibility of becoming intrahepatic cholangio-carcinoma in the clinic .We should learn more about the clinical characteristics of patients with regular review .Hepatectomy is an effective treatment for hepatolithiasis with intrahepatic cholangiocarcinoma ,it can improve long-term survival of some patients .
