胆总管囊肿癌变的临床特点及预后分析  

ANALYSIS OF CLINICAL SYMPTOM AND PROGNOSIS IN MALIGNANT CHANGE OF CHOLEDOCHAL CYST

作　　者：冯继峰[1] 陈文有[1] 陈达丰[1] 李冉冉[1] 周松[1] 刘静[1] 

机构地区：[1]解放军第175医院(厦门大学附属东南医院),漳州363000

出　　处：《肝胆外科杂志》2010年第5期347-350,共4页Journal of Hepatobiliary Surgery

摘　　要：目的探讨胆总管囊肿癌变的临床特点及预后分析。方法对我院自1988年1月～2008年6月收治的74例胆总管囊肿患者进行回顾性分析。患者性别、年龄、囊肿类型、大小、临床表现、总胆红素(STB)、碱性磷酸酶(ALP)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血淀粉酶(AMS)、影像学诊断(B超、CT、磁共振)、手术方式以及预后进行统计学分析。结果 74例胆总管囊肿中合并癌变9例,癌变率为12.16%。除1例原发性癌外,其余8例均为内引流术后癌变。其中男性3例,女性6例,男女间比例没有显著性差异(P=0.878),但癌变与年龄密切相关(r=0.897,P=0.039),且随着年龄增长癌变率急剧增加,各年龄段癌变率分别为:1～15岁为0%,16～30岁为4.5%,31～45岁为8.7%,46～60岁为15.4%,60～75岁为44.4%。癌变年龄(51.6±16.4)与未癌变年龄(35.9±14.4)具有显著性差异(P=0.004)。囊肿类型(P=0.822)、大小(P=0.207)对于囊肿有无癌变没有显著性差异。黄疸(P=0.004)、STB(P=0.000)、ALP(P=0.015)、AMS(P=0.006)对于诊断囊肿有无癌变具有显著性差异。术后生存3～66个月,中位生存期19.1±18.6月。结论胆总管囊肿是一种癌前病变,癌变与年龄密切相关,随年龄增长癌变率急剧增加。胆总管囊肿癌变临床表现缺乏特异性,术前诊断困难,预后不佳。黄疸、STB、ALP、AMS对诊断囊肿有无癌变具有显著性差异。对确诊为胆总管囊肿的病人,应尽早行囊肿切除,肝管空肠吻合术,纠正胆胰管汇合异常,以预防癌变的发生。Objective To analyse the clinical symptom and prognosis in malignant change of choledochal cyst.Methods We analysed retrospectively the data including gender,age,type,size,clinical symptom,laboratory examination,imaging diagnostic,the ways of operation and the survival of patients with malignant change in 74 cases of choledochal cysts in our hospital from 1988 to 2008.Results Among the 74 patients,9 cases（3 males and 6 females）（P=0.878） had carcinomas arising from choledochal cysts at the mean age of 51.6±16.4 years（range： 22 to 72 years old） with the incidences of 12.16%（9/74）,which was significant difference compareing with no malignant change groups with the mean age of 35.9±14.4（P=0.004）.The incidences of malignant change for different groups were closely related to the age increased（r=0.897,P=0.039）： 0 for 1～15 group（0/7）,4.5% for 16-30 group（1/22）,8.7% for 31-45 group（2/23）,15.4% for 46-60 group（2/13）,and 44.4% for 61-75 group（4/9）,respectively.There was no significant difference in the type（P=0.822） and size（P=0.207） of malignant change of choledochal cysts.Significant differences were found in jaundice（P=0.004）,STB（P=0.000）,ALP（P=0.015） and AMS（P=0.006）.The surviving time was 3 months to 66 months,and the middle survival was 19.1±18.6 monthes.Conclusion Choledochal cyst is a premalignant lesion,and the incidence of malignant change increases remarkably with the age increased.The clinical symptom of malignant change of choledochal cyst is non-specific,the preoperative diagnosis is difficult and the prognosis is poor.Jaundice,STB,ALP and AMS have significant differences in diagnosing the malignant change of choledochal cyst.Total cyst excision and hepaticojejunostomy is an effective and safe treatment for patients with choledochal cyst in order to reduce the chance of subsequent development of malignancy.

关 键 词：胆总管囊肿 癌变 预后 分析 

分 类 号：R735.8[医药卫生—肿瘤]