肝内胆管细胞癌与肝细胞癌临床特征的对比分析

发布时间：2018-02-11 12:25

本文关键词： 肝内胆管细胞癌肝细胞癌病因碱性磷酸酶 γ谷氨酰转肽酶肿瘤标志物临床特征病理特点　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本文通过分析肝内胆管细胞癌(Intrahepatic Cholangiocarcinomar,ICC)的临床特征,并且与肝细胞癌(Hepatocellular Carcinoma,HCC)的临床特征相比较,以加深对肝内胆管细胞癌的认识,为临床提供更多有价值的信息,提高诊治水平。方法:选择2010年1月至2016年12月期间就诊于吉林大学中日联谊医院的38例ICC患者及同期随机抽取的80例HCC患者的病例资料,所有患者均接受手术治疗,且术后均经病理学诊断证实。回顾性的对比分析两组的基本情况、病因、肝功能生化指标、肿瘤标志物、临床表现、影像学表现及病理特征等方面的关系。结果:通过比较分析ICC组与HCC组的临床资料发现:两组相比较性别无明显差异,HCC组男性比例明显高于女性,而ICC组中男性比例略高于女性。ICC组的中位年龄较HCC组高。ICC多合并肝内胆管结石,但HBV感染、HCV感染及肝硬化患者比例均低于HCC组。两组主要临床表现均为腹部胀痛,分别为17例(占44.74%)和39例(占48.8%),但ICC组中因体检发现占位的患者明显高于HCC组。两组AST、ALT、TBIL阳性率及检测值对比均无统计学差异。ICC组ALP、GGT的阳性率及检测值均高于HCC组。ICC组AFP阳性率及检测值均明显低于HCC组。其中ICC组AFP400ng/ml者仅1例(占2.6%),而HCC组AFP400ng/ml者26例(占32.5%)。ICC组CA19-9阳性率及检测值明显高于HCC组。其中ICC组CA19-9100U/ml者24例(占63.16%)明显高于HCC组的9例(11.3%)。两组CEA阳性率无统计学差异。影像学方面,ICC多发生于肝左叶,以单发为主,且多伴有肝内胆管扩张及腹腔淋巴结肿大。病理方面,ICC组与HCC组肿瘤均以中低分化程度为主。ICC组中低分化的比例(89.5%)明显高于高分化所占比例(10.5%)。且ICC多伴有局部浸润及脉管浸润。结论:与HCC组患者相比,ICC组患者具有以下特点:1.ICC患者平均发病年龄较大;2.ICC组以体检发现为首诊原因的患者相对较多;3.ICC组ALP及GGT升高的患者较多,有助于ICC的诊断;4.ICC组CA19-9升高(尤其是CA19-9100U/ml)的患者较多,但AFP升高患者较少;5.ICC多发生于肝左叶,以单发肿瘤为主,且有肝内胆管结石的患者较多;6.ICC组织分化程度低,恶性程度高,易侵犯周围组织或器官。
[Abstract]:Objective: to study the clinical features of intrahepatic cholangiocarcinoma (ICC) and compare it with that of Hepatocellular cholangiocarcinoma (HCC) in order to provide more valuable information for clinical practice. Methods: from January 2010 to December 2016, 38 patients with ICC and 80 patients with HCC who were randomly selected from China and Japan Friendship Hospital of Jilin University were selected. All the patients received surgical treatment. The basic condition, etiology, biochemical index of liver function, tumor marker, clinical manifestation were analyzed retrospectively. Results: by comparing and analyzing the clinical data of ICC group and HCC group, we found that there was no significant difference between the two groups. The median age in ICC group was slightly higher than that in female group. The median age of HBV group was higher than that of HCC group, but the incidence of HBV infection and cirrhosis was lower than that of HCC group. The main clinical manifestations of both groups were abdominal distending pain. There were 17 cases (44.74%) and 39 cases (48.8%) in the ICC group, but the positive rate and the detection value of the HCC group were higher than that of the HCC group. There was no statistical difference between the two groups. The positive rate and detection value of AFP in the ICC group were significantly lower than those in the HCC group, in which only 1 case (2.66%) had AFP400ng/ml in the ICC group, while 26 cases (32.5%) in the HCC group were significantly higher than those in the HCC group, and 24 cases (63.16%) of CA19-9100U/ml in the ICC group were significantly higher than those in the HCC group. There was no significant difference in the positive rate of CEA between the two groups. Mainly single, Most of them were accompanied by intrahepatic bile duct dilatation and abdominal lymphadenopathy. Pathologically, the tumors in ICC group and HCC group were mainly of middle and low differentiation. The proportion of middle and low differentiation in ICC group was significantly higher than that in high differentiation group (10.5%), and ICC was associated with local dipping. Conclusion: compared with the HCC group, the average age of onset is higher. 2. The first reason for the first diagnosis is that the ALP and GGT in the ICC group are higher than those in the ALP group, and the number of the patients in the ICC group is higher than that in the ALP group, and the number of the patients in the ICC group is higher than that in the ALP group. 4. There were more patients with elevated CA19-9 (especially CA19-9100U / ml) in ICC group, but less patients with elevated AFP. 5.ICC mostly occurred in the liver Zuo Ye, and the patients with intrahepatic cholangiolithiasis had lower differentiation degree and higher malignant degree than those with intrahepatic cholangiolithiasis. To encroach upon surrounding tissues or organs.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

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