论文部分内容阅读
对９５例胆管中下段癌进行了临床总结，并重点对９例黄疸前期获明确诊断和治疗者进行了分析。结果显示：７０５２％的胆管中下段癌有黄疸前期症状。这些症状持续时间从１个月至１９个月不等，主要为反复上腹部、右上腹部或腰背部隐痛或胀痛不适，伴或不伴有发热、食欲不振和体重减轻。黄疸前期的根治性切除率明显高于黄疸期（８／９比３９／８６，ｘ２＝４．５５９，Ｐ＜００５）。９例黄疸前期胆管中下段癌的临床特点为：①胆囊切除术后右上腹疼痛症状不缓解或明显加重，并伴胆管明显扩张；②“症状性胆囊结石”伴有不明原因的胆道扩张；③胆道Ｔ管外引流术后不能夹闭Ｔ管，或行“Ｏｄｄｉ括约肌缩窄”切开后短时间内症状再发或加重；④不明原因的反复右上腹隐痛或胀痛不适，且进行性加重。提示，黄疸前期胆管中下段癌有临床特点，其早期诊断有助于提高切除率和远期疗效。
Ninety-five cases of bile duct middle and lower segment carcinomas were clinically summarized, and nine cases of jaundice who were diagnosed and treated in the early stage were analyzed. The results showed that: 70 52% of the lower middle of the bile duct cancer with early symptoms of jaundice. The duration of these symptoms ranged from 1 month to 19 months, and was mainly due to repeated abdominal pain, upper right abdomen or low back pain or discomfort, with or without fever, loss of appetite, and weight loss. Radical resection rate of early jaundice was significantly higher than that of jaundice (8/9 vs. 39/86, x2 = 4.559, P < 0.05). The clinical features of 9 cases of early bile duct carcinoma in the early stage of jaundice were as follows: 1 The pain symptoms in the right upper quadrant after cholecystectomy were not relieved or significantly worsened, with obvious dilatation of the bile duct; 2 “symptomatic gallbladder stones” with unexplained biliary tract enlargement; 3 After the external drainage of the biliary T-tube, the T-tube could not be clipped, or the symptoms of “Oddi sphincter contraction” could be recurred or aggravated within a short time after the incision; 4 The unexplained repeated right upper quadrant pain or discomfort was discomfort and progressively worsened. . It is suggested that the early stage of jaundice has clinical features in the lower and middle segment of the bile duct, and its early diagnosis can help to increase the resection rate and long-term efficacy.