周围型肝内胆管细胞癌的诊断和治疗

目的 探讨周围型肝内胆管细胞癌(PICC)的诊断及外科治疗，提高其诊治水平。方法 总结分析1991～2000年间我科收治的46例PICC病人诊断、治疗及预后的资料。结果 (1)本病早期无特异性临床表现，部分病例可并存乙型肝炎(20％)、肝硬化(45％)，部分伴有肝内胆管结石(20％)，血清AFP升高(30％)；(2)影像学检查：B超、CT、MRI的诊断率分别为90．0％、95．4％及100．0％；(3)手术切除率为64．0％．全组病例的1、3、5年生存率分别为60．0％、33．0％及26．0％；(4)生存5年以上的12例病人中，直径≤3cm的小肝癌9例，包膜完整的肿块型直径位于3～5cm肝癌3例，术后均辅助性放射治疗和选择性肝动脉灌注化疗。结论影像学检查能在早、中期提供临床线索，但缺乏特异性血清肿瘤标志物，治愈性切除术加辅助治疗可获得良好生存率。

Diagnosis and treatment of peripheral intrahepatic cholangiocarcinoma

Objective To summarize the experience in diagnosis and treatment of peripheral intrahepatic cholangiocarcinoma (PICC). Methods The clinical data of 46 patients with PICC treated in our hospital from 1991 to 2000 were retrospectively analyzed to determine the clinicopathological features, surgical treatments and prognosis of the disease. Results No typical clinical manifestations were found at the early stage and some of the patients had a history of hepatitis B (20%), cirrhosis (45%), elevation of serum aspha-fetaprotein (AFP) (30%) or intrahepatic stones (20%). The diagnostic rate was 90%, 95.4% and 100% by B-mode ultrasonography, CT and MRI, respectively. The resection rate for the tumor was 64% and the 1-, 3- and 5-year survival rate in the patients was 60%, 33% and 26%, respectively. Of the patients surviving for over 5 years, 9 had a cholangiocarcinoma with a diameter less than or equal to 3 cm and 3 had large nodular cholangiocarcinoma with intact capsule. All the 46 patients received radiotherapy and selective hepatic artery perfusion chemotherapy postoperatively. Conclusions PICC lacks specific serum tumor markers. B-mode ultrasonography, CT and MRI can give clues to its diagnosis. Furthermore, early detection and curative resection with adjuvant therapies can achieve good results.