胆总管下端结石合并胆总管下端癌的临床诊断及治疗

目的:研究胆总管下端结石合并胆总管下端癌的临床特点及诊治要点。方法:回顾性分析2005年1月-2012年1月间入院诊治的35例胆总管下端结石合并胆总管下端癌的临床资料，统计患者年龄与胆石症病史数据。并选取同期入院诊治的单纯胆管下端癌患者35例为对照A组，单纯胆总管下端结石的患者35例作为对照B组。对比三组患者血清肿瘤标记物水平。结果:35例胆管下端癌患者均经诊断证实存在胆管结石。所有患者术前均经B超检查，明确诊断者15例，阳性率为42.86%；24例经CT检查，确诊18例，阳性率为75.00%；30例行MRCP检查，确诊11例，阳性率为36.67%；14例行ERCP检查，确诊14例，阳性率为100.00%。实验组CA-50为(142.95±46.92)U/L，CA-199为(208.80±116.64)U/L，CEA为(18.40±3.59)μg/L；对照A组CA-50为(210.44±67.59)U/L，CA-199为(611.83±389.52)U/L，CEA为(47.41±20.97)μg/L；对照B组CA-50为(15.17±3.06)U/L，CA-199为(17.33±4.15)U/L，CEA为(7.69±3.85)μg/L。三组差异显著(P<0.05)。胆总管下端结石合并胆总管下端癌患者的年龄多为60~69岁，胆石症病史以9~13年的为多，10年以上胆石症病史的发病率高于10年以下病史者。结论:长期胆管结石病史、老年胆管结石患者，血清肿瘤因子CA-50、CA-199、CEA显著升高的患者，应高度警惕胆管癌。B超的诊断阳性率较低，可结合多种影像学诊断方法共同诊断。

Clinical diagnosis and treatment of the lower common bile duct stone with the lower common bile duct carcinoma

Objective:To study clinical characteristics and main points of diagnosis and treatment of the lower common bile duct stone with the lower common bile duct carcinoma.Methods:A retrospective analysis was performed on 35 cases with lower common bile duct stone and lower common bile duct carcinoma,with 35 bile duct carcinoma patients as control group A,35 pure lower common bile duct patients as control group B.Results:35 cases with lower bile duct carcinoma were confirmed with bile duct stones.All patients were examined by preoperative B ultrasonic ex-amination,diagnosed in 15 cases,with positive rate 42.86%.18 cases were diagnosed in 24 cases by CT examination, and the positive rate was 75.00%.11 cases were diagnosed in 30 cases underwent MRCP examination,and positive rate was 36 .67 %.1 4 cases were diagnosed in 1 4 cases underwent ERCP examination,and the positive rate was 100.00%.In experiment,CA -50 was(142.95 +46.92)U /L,CA -199 for(208.80 +116.64)U /L,CEA for(18.40+3.59)μg/L.In control group A,CA -50 was(210.44 +67.59)U /L,CA -199 for (611.83 +389.52)U /L,CEA for(47.41 +20.97)μg/L.In control group B,CA -50 was(15.17 +3.06)U /L,CA -199 for(17.33 ±4.15)U /L and CEA for(7.69 +3.85)μg/L.There was significant difference in 3 groups (P <0.05).The lower common bile duct stone with bile duct carcinoma patients were 60 ~69 years old.More cholelith disease history was 9 ~13 years. Cholelith disease incidence over 10 years was higher than the less than 10 years.Conclusion:Patients with long -term history,bile duct calculi in elder with biliary calculi,significantly increased in CA -50,CA -199 and CEA, should be more vigilant about cholangiocarcinoma.Positive rate of ultrasound diagnosis is low,which should be com-bined with a variety of other imaging diagnostic methods.