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目的:探讨肝胆管结石合并胆管癌的临床表现特征和诊治经验。方法:分析了自2001年1月到2009年8月我院收治的30例肝胆管结石合并胆管癌患者的临床资料。结果:肝胆管结石合并胆管癌术前确诊10例,术中病理检查确诊14例,术后病理检查发现6例。左肝胆管癌16例,占53.3%,右肝胆管癌7例占23.3%,肝门部胆管癌5例占16.7%,其余2例为左右肝都有。肿瘤根治性切除术17例(56.7%),姑息性手术9例(30%),单纯活检4例(13.3%)。在30例随访资料中,根治性切除术者平均存活时间26个月。存活1年以上10例,2年以上5例,3年以上2例;姑息治疗者术后平均生存9个月;其余的≤4个月。结论:胆石症状易反复发作,胆道病史较长大于10年且术前CA199>2500 ng/mL的患者应高度怀疑合并有胆管癌。
Objective: To investigate the clinical manifestations and diagnosis and treatment of hepatolithiasis with cholangiocarcinoma. Methods: The clinical data of 30 patients with hepatolithiasis admitted to our hospital from January 2001 to August 2009 were analyzed. Results: Hepatic bile duct stones with cholangiocarcinoma were diagnosed preoperatively in 10 cases, intraoperative pathological examination confirmed in 14 cases, postoperative pathological examination found in 6 cases. There were 16 cases of left cholangiocarcinoma, accounting for 53.3%, 7 cases of right cholangiocarcinoma, 23.3% of cases, and 5 cases of hilar cholangiocarcinoma, accounting for 16.7%. The other 2 cases had left and right hepatic carcinoma. Radical resection in 17 cases (56.7%), palliative surgery in 9 cases (30%), biopsy in 4 cases (13.3%). In the 30 follow-up data, the average survival time of radical resection was 26 months. Survival of more than 1 year in 10 cases, more than 2 years in 5 cases, more than 3 years in 2 cases; palliative treatment of patients with an average survival of 9 months; the rest of ≤ 4 months. CONCLUSIONS: Cholelithiasis is prone to recurrent episodes. Patients with a history of biliary disease longer than 10 years and preoperative CA199> 2500 ng / mL should be highly suspected of having cholangiocarcinoma.