肝内胆管结石合并肝胆管癌32例诊治分析 同济

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1、中国实用外科杂志2009年6月第29卷第6期·499·论著文章编号：1005-2208（2009）06-0499-03肝内胆管结石合并肝胆管癌32例诊治分析姜立，陈孝平【摘要】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4

2、6.9%（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。【关键词】肝内胆管结石；胆管癌中图分类号:R6文献标志码:AHepatolithiasisassociatedwithcholangiocarcinoma:areportof32casesJIANGLi，CHENXiao-ping.InstituteofHepatopancreatobiliarySurgery

3、,TongjiHospital,TongjiMedicalCollege,HuazhongUniversityofScienceandTechnology,Wuhan430030,ChinaCorrespondingauthor：CHENXiao-ping,E-mail：chenxp@medmail.comAbstractObjectiveTostudytheclinicalfeatures,diagnosisandtreatmentofhepatolithiasisassociatedwithcholangiocaminoma.MethodsTheclinicaldataof32patien

4、tswithhepatolithiasisassociatedwithcholangiocarcinomaadmittedfrom1993to2007atTongjiHospitalofTongjiMedicalCollegeofHuazhongUniversityofScienceandTechnologywereanalyzedretrospectively.ResultsCholangiocarcinomaoccurredin1.9%ofpatientswithhepatolithiasis,withdiagnosisestablishedpreoperativelyin19(59.4%

5、)patients.Theincidenceofperipheralcholangiocaminomaandhilarcholangiocaminomawas43.8%and50%respectively.Only10(31.3%)patientsunderwentradicalresection,andother15(46.9%)patientsreceivedpalliativemanagement.Inthe28patientsfollowed-upclosely,averagesurvivaltimewas22monthsinradicalsurgerygroup,whereasthe

6、averagesurvivaltimewasabout9monthsinpalliativeoperationgroup.ConclusionLong-termchronicinflammationduetohepatolithwithinthebileductsystemcontributestothedevelopmentofcholangiocarcinoma.Theradiologicandclinicalfindingsofpatientswithlong-termhepatolithiasisandahistoryofbiliaryoperationshouldbeattentiv

7、elyinvestigatedforthepossiblepresenceofacholangiocarcinoma,ofwhichtheprognosisisstillpoorbecauseofthedifficultytoachieveearlydiagnosisandradicalresection.Keywordshepatolithiasis；cholangiocarcinoma随着胆管