肝胆管结石合并胆管癌漏诊及防治(附52例分析)

目的 探讨肝胆管结石与胆管癌的关系,总结该病的漏诊原因及防治经验.方法 回顾性分析1998年1月～2010年12月经病理证实的52例肝内胆管结石合并胆管癌的临床资料,并对其诊断、治疗和预后进行总结.结果 52例胆管癌的发生率占同期肝内胆管结石患者的4.17％(52/1248).其中,术前诊断者17例,术前诊断正确率32.7％( 17/52),术前漏诊率达67.3％(35/52).术前漏诊的35例中,26例经术中探查结合病理切片得到确诊,7例术中未发现但术后病理证实为胆管癌,其余2例为取石及肝叶切除术后数月病情恶化,再次手术得以证实.术前及术中诊断的患者有21例获得根治性切除,切除率为40.4％(21/52).肝胆管癌行根治切除者平均生存34.2个月(14～65)个月；仅作姑息性内或外引流者平均生存11.7个月(3～14个月)；仅作剖腹探查者平均生存2个月(1～4个月).结论 肝内胆管结石合并胆管癌的早期诊断困难,漏诊率高.根治性切除较姑息性手术能显著提高患者的生存率和生存质量.重视该病,早期诊断、早期治疗,争取根治性切除能提高肝胆管结石合并胆管癌疗效.

Prevention and treatment of cholangiocarcinoma accompanied with hepatolithiasis(52 cases)

【Objective】 To explore the relationship between cholangiocarcinoma and hepatolithiasis,summarize the reasons of misdiagnosis,prevention and treatment of cholangiocarcinoma accompanied with hepatolithiasis.【Methods】 Fifty two patients bearing cholangiocarcinoma accompanied with hepatolithiasis treated in Xiangya Hospital from Jan 1998 to Dec 2010 were studied.The clinical,pathological and follow-up data of the patients were reviewed retrospectively.【Results】 The incidence of cholangiocarcinoma companying with hepatolithiasis was 4.17%(52/1248).The percentage of preoperative correct diagnosis was 32.7%(17/52),while the misdiagnosis rate was 67.3%(35/52).Among the 35 cases of misdiagnosis,26 cases were verified pathologically during the operation,7 cases were verified pathologically after the operation,and other two cases were correctly diagnosed by re-operation only after the recurrence of the tumor several months later.The radical operation was carried out in 40.4%(21/52) of the patients.The overall average survival time was about 34.2 months(14～65 months) and 11.7 months(3～14 months) for patient accepted radical or palliative operations respectively.For patients accepted only exploring operations,the average survival time was about 2 months(1～4 months).【Conclusion】 Cholangiocarcinoma companying hepatolithiasis is difficult to be diagnosed in the early stage.In patients of hepatolithiasis who are older than 45 years and have a long history of recurrent cholangitis,progressive jaundice,or intractable abdominal pain,the possibility of accompanying cholangiocarcinoma should be considered.The key to improve the therapeutic effectiveness is early diagnosis,early treatment and striving for radical operation.