论文部分内容阅读
目的探讨肝内胆管结石合并肝胆管癌的临床特点和诊治经验。方法对1993-2007年间华中科技大学同济医学院附属同济医院肝胆胰外科研究所收治的32例肝内胆管结石并发肝胆管癌病例的临床资料进行回顾性分析。结果32例肝胆管癌占同期肝内胆管结石病人的1.9%,术前确诊率为59.4%(19/32)。其中周围型胆管癌占43.8%(14/32),肝门部胆管癌占50%(16/32)。肿瘤根治性切除率为31.3%(10/32),姑息性手术46.9%(15/32)。有随访资料的28例中,根治组平均存活时间22个月,姑息手术组平均存活9个月。结论肝内胆管结石造成的胆管系统内慢性炎症环境可能是诱发胆管癌的重要原因。对于有长期肝内胆管结石病史以及胆道手术史的病人,必须警惕并发肝胆管癌的可能。该病的早期诊断和根治性切除率低,预后差。
Objective To investigate the clinical features and diagnosis and treatment of intrahepatic bile duct stones combined with hepatobiliary ductal carcinoma. Methods The clinical data of 32 cases of intrahepatic biliary calculi complicated with hepatolithiasis admitted from Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology from 1993 to 2007 were analyzed retrospectively. Results 32 cases of hepatobiliary carcinoma accounted for 1.9% of patients with intrahepatic bile duct stones during the same period, and the diagnosis rate was 59.4% (19/32) before operation. Peripheral cholangiocarcinoma accounted for 43.8% (14/32), hilar cholangiocarcinoma accounted for 50% (16/32). The radical tumor resection rate was 31.3% (10/32), palliative surgery 46.9% (15/32). The follow-up data of 28 cases, the average survival time of the radical group 22 months, palliative surgery group average survival of 9 months. Conclusion Intrahepatic bile duct stones caused by the chronic inflammatory environment within the bile duct may be an important cause of cholangiocarcinoma. For patients with a history of long-term intrahepatic bile duct stones and biliary surgery, the possibility of concurrent hepatobiliary cancer must be observed. The disease early diagnosis and radical resection rate is low, the prognosis is poor.