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目的 探讨末梢型肝内胆管细胞癌 (PIHCC)的诊断及外科治疗结果 ,以提高其诊治水平。 方法 回顾性分析 1970～ 1999年间外科治疗的 2 0例PIHCC患者诊断、治疗及预后的资料。 结果 (1)本病缺乏特异性临床表现 ,部分病例可并发乙型肝炎 (35 0 % )、肝硬化 (4 5 0 % )和血清AFP升高 (2 5 0 % ) ;(2 )影像学检查 :B超、CT、MRI及ECT的诊断率分别为 90 0 % (18/ 2 0 )、94 4% (17/ 18)、3/ 3及 4/ 4;(3)手术切除率为 6 0 % ,全组病例的 1、3、5年生存率分别为 5 5 0 % (11/ 2 0 )、35 0 % (7/ 2 0 )及 2 0 0 % (4 / 2 0 ) ,其中肝切除术病例分别为 83 3% (11/ 12 )、5 8 3% (7/ 12 )、33 3% (4 / 12 ) ;(4 )生存 5年以上的 4例患者中 ,直径≤ 3cm的小肝癌 3例、包膜完整的结节型大肝癌 1例 ,且术后均辅助选择性肝动脉灌注化疗 ,有助于生存率的提高。 结论 本病缺乏特异性血清肿瘤标志物 ,治愈性切除术(包括术后辅助治疗 )可获得良好生存率
Objective To investigate the diagnosis and surgical outcomes of peripheral intrahepatic cholangiocarcinoma (PIHCC) in order to improve its diagnosis and treatment. Methods The data of diagnosis, treatment and prognosis of 20 patients with PIHCC treated surgically between 1970 and 1999 were retrospectively analyzed. Results (1) There was no specific clinical manifestation of the disease. Some cases were complicated by hepatitis B (35.0%), cirrhosis (4.50%), and elevated serum AFP (25%). (2) Imaging. Examinations: The diagnostic rates for B ultrasound, CT, MRI, and ECT were 90% (18/20), 94% (17/18), 3/3, and 4/4; (3) Surgical resection rate was 6 At 0 %, the 1-, 3-, and 5-year survival rates for the whole group were 550 (11/20), 35.0 (7/20), and 20% (4/20), respectively. Hepatectomy cases were 83 3% (11/12), 583% (7/12), 33 3% (4/12), respectively; (4) In 4 patients who survived more than 5 years, the diameter was ≤ 3cm Three cases of small hepatocellular carcinoma and one case of nodular hepatocellular carcinoma with intact capsules were all assisted with selective hepatic arterial infusion chemotherapy, which contributed to the improvement of survival rate. Conclusion The disease lacks specific serum tumor markers, and the curative resection (including postoperative adjuvant therapy) can achieve good survival rate