摘要
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。
Objective To investigate the points of diagnosis and treatment of the bile duct stones combined cholangiocar- cinoma. Methods The clinical data of 36 cases diagnosed as bile duct stone with cholangiocarcinoma were analyzed retro- spectively. Results The rate of bile duct stones with cholangiocarcinoma accounted for 5.3%, the main clinical manifesta- tions were right upper quadrant pain and repeated cholangitis, but which was the lack of specificity. AKP, ~/-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 signifi- cantly 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.
出处
《中国现代医生》
2012年第18期150-151,共2页
China Modern Doctor
关键词
肝胆管结石
胆管癌
诊断
Bile duct stones
Cholangiocarcinoma
Diagnosis
