中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (06): 499-501.

• 论著 • 上一篇    下一篇

肝内胆管结石合并肝胆管癌32例诊治分析

姜 立， 陈孝平   

  1. 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，湖北武汉430030
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-06-10 发布日期:2009-06-10

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-06-10 Published:2009-06-10

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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。

关键词: 肝内胆管结石, 胆管癌

Abstract:

Hepatolithiasis associated with cholangiocarcinoma: a report of 32 cases JIANG Li，CHEN Xiao-ping. Institute of Hepatopancreatobiliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China Corresponding author：CHEN Xiao-ping, E-mail：chenxp@medmail.com Abstract Objective To study the clinical features, diagnosis and treatment of hepatolithiasis associated with cholangiocaminoma. Methods The clinical data of 32 patients with hepatolithiasis associated with cholangiocarcinoma admitted from 1993 to 2007 at Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology were analyzed retrospectively. Results Cholangiocarcinoma occurred in 1.9% of patients with hepatolithiasis, with diagnosis established preoperatively in 19 (59.4%) patients. The incidence of peripheral cholangiocaminoma and hilar cholangiocaminoma was 43.8% and 50% respectively. Only 10 (31.3%) patients underwent radical resection, and other 15(46.9%) patients received palliative management. In the 28 patients followed-up closely, average survival time was 22 months in radical surgery group, whereas the average survival time was about 9 months in palliative operation group. Conclusion Long-term chronic inflammation due to hepatolith within the bile duct system contributes to the development of cholangiocarcinoma. The radiologic and clinical findings of patients with long-term hepatolithiasis and a history of biliary operation should be attentively investigated for the possible presence of a cholangiocarcinoma, of which the prognosis is still poor because of the difficulty to achieve early diagnosis and radical resection.

Key words: hepatolithiasis, cholangiocarcinoma