肝胆管结石合并胆管癌的诊断及治疗体会

目的探讨肝胆管结石合并胆管癌的诊断及治疗要点。方法对36例诊断为肝胆管结石合并胆管癌患者的临床资料进行回顾性分析。结果肝胆管结石合并胆管癌患者占肝胆管结石患者的5-3％，其临床表现主要以右上腹疼痛及反复的胆管炎发作为主，但缺乏特异性。术前胆管癌组患者AKP、γ-GT均不同程度升高，ALT升高32例，总胆红素升高14例，与非胆管癌组相比，AKP、γ—GT、ALT、TBIL均显著升高（P〈0．01），且胆管癌组术前血CA19—9及CEA显著高于非胆管癌组（P〈0．01），而CA125及AFP在两组间无显著差异（P〉0．05）。手术后随访显示，行根治性手术的患者中位生存期为28个月，姑息性手术治疗的患者中位生存期为11个月，显著低于根治性手术患者（P〈0．05），行根治性手术治疗的患者第1、2、3年生存率均显著高于姑息性治疗的患者（P〈0．05）。结论肝胆管结石合并胆管癌的临床表现缺乏特异性，对有肝内占位、血CA19—9及CEA显著升高者应行病例活检确诊，并积极的行根治性手术治疗，从而有助于提高患者的生存期。

Experience of diagnosis and treatment about bile duct stone combined cholangiocarcinoma

Objective To investigate the points of diagnosis and treatment of the bile duct stones combined cholangiocarcinoma.Methods The clinical data of 36 cases diagnosed as bile duct stone with cholangiocarcinoma were analyzed retrospectively.Results The rate of bile duct stones with cholangiocarcinoma accounted for 5.3%,the main clinical manifestations were right upper quadrant pain and repeated cholangitis,but which was the lack of specificity.AKP,γ-GT,ALT,TBIL in cancer group increased significantly compared with that in non-cancer group(P < 0.01),including 32 cases with ALT increase and 14 cases with the total bilirubin increase.and serum CA19-9 and CEA in cancer group were significantly higher than that in non-cancer group(P < 0.01),while CA125 and AFP had no significant difference between the two groups(P > 0.05).Post-operative follow-up show,line radical surgery patients-bit survival of 28 months,palliative surgical treatment of patients median survival was 11 months,which was significantly less than radical surgery patients(P < 0.05),and 1,2 and 3 year survival rates of patients-line radical surgery were significantly higher than the patients with the palliative treatment(P < 0.05).Conclusion The clinical manifestations of bile duct stones combined cholangiocarcinoma is lack of specificity.For patients with intrahepatic or blood CA19-9 and CEA increasing should be confirmed by biopsy,and radical surgery patients should be done,which help to improve the survival of patients.