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目的探讨影像学检查和CA199、CEA的测定对肝外胆管癌(extrahepaticcholangiocarcinoma,EHCC)的诊断价值。方法回顾性分析1995～2003年107例肝外胆管癌US、CT、MRCP、ERCP、PTC诊断结果。其中51例进行了CA199、CEA的测定,并与42例胆道良性病变进行对照研究。结果US、CT、ERCP肿块显示率分别为708%、602%、690%;US、CT、MRCP、ERCP、PTC定位诊断准确率分别为729%、759%、100%、714%、769%。EHCC组与胆道良性病变组相比较,血清CA199、CEA和胆汁CA199值明显升高(P<001,P<005和P<001)。血清CA199、CEA和胆汁CA199的敏感性分别为863%、255%、409%,其特异性分别为875%、952%、788%。结论MRCP对EHCC诊断优于US、CT、ERCP及PTC,血清CA199的测定是EHCC术前可靠的定性诊断手段。
Objective To investigate the diagnostic value of imaging and CA199 and CEA in the diagnosis of extrahepatic cholangiocarcinoma (EHCC). Methods Retrospective analysis of 107 cases of extrahepatic cholangiocarcinoma US, CT, MRCP, ERCP, PTC diagnosis from 1995 to 2003. Among them, 51 cases were tested for CA199 and CEA and compared with 42 cases of benign biliary lesions. Results The diagnostic rates of US, CT and ERCP were 708%, 602% and 690% respectively. The diagnostic accuracy of US, CT, MRCP, ERCP and PTC was 729%, 759%, 100%, 714% and 769%, respectively. The serum CA199, CEA and bile CA199 values in EHCC group were significantly higher than those in benign biliary group (P <001, P <005 and P <001). The sensitivities of serum CA199, CEA and bile CA199 were 863%, 255% and 409%, respectively, and their specificity were 875%, 952% and 788% respectively. Conclusion MRCP is superior to US, CT, ERCP and PTC in the diagnosis of EHCC. Serum CA199 is a reliable diagnostic method for EHCC before operation.