肝胆管结石合并肝内胆管癌的临床诊治分析.docxVIP

肝胆管结石合并肝内胆管癌的临床诊治分析 陈少华 陈鹏 吴哲 陈永标 幕宁 (解放军南京军区福州总医院肝胆外科福建福州350025) 【摘要】目的探讨肝胆管结石合并肝内胆管癌的临床特点、诊断和治疗。方法 总结2002年1月至2012年1月我院收治的46例经手术切除的肝胆管结石并发 肝内胆管癌的临床资料。结果46例肝内胆管癌的发牛率占同期肝胆管结石患 者的3.9%(46/1186)o全组行根治性切除26例，姑息性切除14例，其1、3、5 年生存率分别为92.3%、53.8%、30.8%和57.1%、14.3%、0,两者比较有显著性 差异。结论 长期肝胆管结石的刺激和胆道感染可致胆管癌的发牛。详尽的影像 学检查可提高术前诊断率，提高疗效的关键是早期诊断及争取根治性切除，姑息 性切除可提高患者牛活质量。 【关键词】肝胆管结石 肝内胆管癌 手术治疗 【中图分类号】R657.4 【文献标识码】A 【文章编号】2095-1752 (2013) 25-0080-02 Clinical diagnosis and treatment of hepatolithiasis complicated with cholangiocarci noma CHEN Shao-hua,CHEN Peng,Wu Zhe,CHEN Yong-biao,MU Ning. (Department of Hepatobiliary Surgery,Fuzhou General Hospital,Fuzhou 350025,China) [Abstract] Objective： To discuss the clinical characteristics, diagnosis and treatment of hepatolithiasis complicated with cholangiocarcinoma.Methods： The clinical date of 46 patients of hepatolithiasis complicated with cholangiocarcinoma treated by excision between January 2002 and January 2012 in Fuzhou General Hospital were retrospectively analyzed.Results： The incidenee of cholangiocarcinoma companying with hepatolithiasis was 3.9%(46/1186). Radical resection were performed in 26 patients, and palliative operations were performed in 14 patients. 1,3 and 5 year survival rates of patients was about 92.3%^ 53.8%、30.8%； 57.1%、 14.3% 0 respectively, and they had sign ifica nt d iff ere nee betwee n two groups. Conclusions： Long term recurrent irritation and infection after hepatolithiasis and is an importa nt cause for the developme nt of chola ngiocarci no ma. Detailed imaging exami nation can improve the rate of preoperative diag no sis. The key to improve the therapeutic effectiveness is early diagnosis and striving for radical operation. Palliative operation can improve the quality of live. 【Keywords］ Hepatolithiasis Chola ngiocarci noma Surgery 肝胆管结石合并长期、反复胆管炎，可导致肝内胆管癌的发生，已得到 多数学者的认同［1］。但由于该病临床症状缺乏特异性，往往被胆石症、胆管炎 的症状所掩盖，常导致临床漏诊、误诊或延误治疗［2］。为进一步了解其诊断、 治疗规律，我们对本院2002年1月?2012年1月共46例经手术和病理确诊为 该病的临床资料进行诊治分析，现报告如下。 一、临床资料 ?