肝门胆管癌的临床诊断

目的：探求实用和有效的诊断肝门胆管癌的方法。方法：对61例肝门胆管癌及50例良性胆道疾病（肝门胆管结石伴肝管狭窄、肝门胆管损伤性狭窄）的临床表现，实验室和影像检查结果比较分析。结果：肝门胆管癌的主要表现为梗阻性黄疸和右上腹痛。肝门胆管癌病人血清CA19－9水平显著高于良性对照组（P＜0．01）。血清CA19－9，CEA诊断肝门胆管癌的敏感性和特异性分别是83．6％，17．4％和68％，100％。B超，电脑彩超，CT，MRI诊断肝门胆管癌的敏感性和特异性分别是70％，97％，71．9％，78．3％和95．7％，100％，90．9％，87．5％。所有46例肝门胆管癌病人行MRC均能明确显示胆管梗阻部位和扩张的肝门胆管树。结论：血清CA19－9有助于肝门胆管癌的诊断。彩超，MRI结合MRC是诊断肝门胆管癌的首选影技术。

Clinical diagnosis of hilar cholangiocarcinoma

Objective To seek a practical and effective method for diagnosis of hilar cholangio- carcinoma.Methods Clinical manifestations,laboratory data and images were compared between 61 cases and 50 cases of benign biliary diseases including intrahepatic lithiasis combined with stenosis of hepatic bile duct and traumatic stenosis of proximal bile duct.Results Obstructive jaundice and right upper quadrant pain were major manifestations of hilar cholangiocarcinoma.The value of serum CA19- 9 was significantly higher in patients with hilar cholangiocarcinoma than in those with benign biliary diseases(P<0.01).As for diagnosis of hilar cholangiocarcinoma,the sensitivity and specificity of CA19-9,CEA,type B ultrasonography,color Doppler flow imaging combined with duplex ultrasonog- raphy,CT and MRI in this series were 83.6%,17.4%,70%,97.9%,71.9%,78.3% and 68%, 100%,95.7%,100%,90.9%,87.5%,respectively.The precise location of an obstructing lesion and complete display of the dilated biliary tree were shown in all 46 patients by MR cholangiography. Conclusions Serum CA19-9 may be a useful tumor marker for the diagnosis of hilar cholangiocarcino- ma.We thus suggest that color Doppler flow imaging combined with duplex ultrasonography and MRI combined with MRC be regarded as primary modalities of choice for detecting hilar cholangiocarcino- ma.