肝内胆管结石合并肝内胆管癌的临床分析

发布时间：2018-03-10 11:35

本文选题：肝内胆管结石　切入点：肝内胆管癌　出处：《南昌大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过临床资料分析肝内胆管结石合并肝内胆管癌的临床特征、诊断方法、治疗效果。方法:采用回顾性研究方法,收集南昌大学第一附属医院2010-2014年期间30例病理结果证实为肝内胆管结石合并肝内胆管癌患者的临床资料。通过科室病例查询系统诊断为肝内胆管结石,并在其内筛选出伴有肝内胆管癌的患者,其中经手术治疗并病理学诊断为肝内胆管细胞癌者30例,将其作为观察组。这期间通过手术治疗且术中观察及手术病理结果证实为单纯性肝内胆管结石40例作为对照组。通过本院病例系统及相关科室医疗系统进行相关资料的收集。结果:观察组中肝内胆管结石合并肝内胆管癌术前明确诊断18例,术前的诊断率为60%。术中行快速冰冻病理明确诊断的为8例,术后病理结果明确诊断的为4例。观察组中术前均行B超检查,B超术前明确诊断12例,诊断率为40%。26例行CT检查,CT术前明确诊断18例,诊断率为69.2%。21例行MRI检查,MRI术前诊断15例,诊断率为71.4%。各检查之间采用X~2检验,结果显示CT、MRI的诊断效果明显优于B超,CT和MRI的诊断效果相当。观察组中血清CA19-9、CEA检测值高于正常分别占86.6%、43.3%,对比组中血清CA19-9、CEA检测值高于正常分别占7.5%%、5%,两组间行X~2检验,结果表明血清CA19-9、CEA检测值高于正常所占的比率在两组间的差异是有统计学意义。手术治疗中行根治性切除18例,占60%。姑息性手术8例,占26.7%,单纯活检4例。术后随访28例,根治性切除者平均生存21个月,姑息性治疗者平均生存11个月,单纯活检者平均生存5个月。行前两种手术方式患者的生存期之间行t检验,结果表明根治性切除相对姑息性治疗更能延长患者的生存期。结论:B超、CT、MRI影像学检查与血清CA19-9、CEA的检测,对明确肝内胆管结石合并肝内胆管癌的诊断有较重要的价值,对术中可疑病灶应行快速冰冻病理检查以明确诊断,根治性手术治疗相对于姑息性手术能显著延长患者生存期。
[Abstract]:Objective: to analyze the clinical features, diagnostic methods and therapeutic effects of intrahepatic cholangiolithiasis complicated with intrahepatic cholangiocarcinoma through clinical data. The clinical data of 30 patients with intrahepatic cholelithiasis associated with intrahepatic cholangiocarcinoma were collected from the first affiliated Hospital of Nanchang University from 2010 to 2014. The patients with intrahepatic cholangiocarcinoma were selected, including 30 cases of intrahepatic cholangiocarcinoma diagnosed by operation and pathology. During this period, 40 cases of simple intrahepatic cholelithiasis were proved to be simple intrahepatic cholelithiasis by operation and pathology. Results: 18 cases of intrahepatic cholelithiasis complicated with intrahepatic cholangiocarcinoma were definitely diagnosed before operation in the observation group. The diagnostic rate was 60% before operation, 8 cases were diagnosed by rapid frozen pathology during operation, and 4 cases by pathological results after operation. All the patients in the observation group were examined by B-ultrasound before operation, 12 cases were diagnosed by B-ultrasound before operation. The diagnostic rate was 40%. 26 cases were diagnosed by CT and 18 cases were diagnosed by CT. The diagnostic rate was 69.2%. 15 cases were diagnosed before MRI, and the diagnostic rate was 71.4%. The results showed that the diagnostic effect of CTV-MRI was significantly better than that of B-ultrasound CT and MRI. In the observation group, the detection value of serum CA19-9 MRI was higher than that of the normal group (86.6%, 43.3%, respectively), and the serum CA19-9 level in the control group was higher than that in the control group (7.5%), and the X2 test was performed between the two groups. The results showed that there was significant difference between the two groups in the ratio of serum CA19-9 CEA to normal. 18 cases (60%) underwent radical resection, 8 cases (26.7%) palliative operation, 4 cases simple biopsy, and 28 cases were followed up. The average survival was 21 months for radical resection, 11 months for palliative therapy and 5 months for simple biopsy. The results showed that radical resection was more effective than palliative treatment in prolonging the survival time of patients. Conclusion: MRI and serum CA19-9 CEA are important for the diagnosis of intrahepatic cholelithiasis with intrahepatic cholangiocarcinoma. Rapid frozen pathological examination should be performed for the diagnosis of suspicious lesions during operation. Radical operation can significantly prolong the survival time of patients compared with palliative operation.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.8;R575.62

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