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目的探讨肝内外胆管结石合并胆管癌的临床特征及诊治方法。方法回顾性分析1998—2009年武汉大学中南医院收治的肝内外胆管结石合并胆管癌54例患者的临床资料。结果全组肝内外胆管结石合并胆管癌者的发生率为5.45%;术前诊断率为83.3%。54例均行手术治疗,其中根治性切除率38.9%;病理诊断为腺癌;45例患者(占总数的83.3%)术后平均随访24个月,行根治性手术病例平均存活21个月,行姑息性引流手术病例平均存活8.5个月,仅行探查术病例存活平均3.5个月。结论胆管癌伴有肝内外胆管结石的疗效较差,有可能时应力争行根治性切除。
Objective To investigate the clinical characteristics and diagnosis and treatment of extrahepatic bile duct stones with cholangiocarcinoma. Methods The clinical data of 54 patients with intrahepatic or extrahepatic bile duct stones and cholangiocarcinoma admitted to Central South Hospital of Wuhan University from 1998 to 2009 were retrospectively analyzed. Results The incidence of intrahepatic and extrahepatic bile duct stones with cholangiocarcinoma was 5.45%. The preoperative diagnosis rate was 83.3%. All of the 54 patients underwent radical surgery, of which the radical resection rate was 38.9%; the pathological diagnosis was adenocarcinoma; 45 patients (83.3% of the total) were followed up for an average of 24 months and the mean survival time was 21 months. The average survival of patients undergoing palliative drainage was 8.5 months, while that of exploration alone was 3.5 months on average. Conclusions The curative effect of cholangiocarcinoma with extrahepatic or extrahepatic bile duct stones is poor, and radical excision should be strived when possible.