肝内胆管囊性肿瘤的诊断与治疗  

Diagnosis and treatment of hepatobiliary cystic neoplasms

作　　者：韩冰[1] 吴力群[1] 张斌[1] 郭卫东[1] 张顺[1] 邱法波[1] 曹景玉[1] 

机构地区：[1]青岛大学医学院附属医院肝胆外科,266003

出　　处：《中华肝脏外科手术学电子杂志》2013年第6期25-28,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：山东省自然科学基金(ZR2012HQ039)

摘　　要：目的探讨肝内胆管囊性肿瘤的临床诊治特点和疗效。方法回顾性分析2001年1月至2013年3月在青岛大学医学院附属医院肝胆外科接受诊治的13例肝内胆管囊性肿瘤患者临床资料。其中男1例,女12例;年龄45～75岁,中位年龄55岁。所有患者均签署知情同意书,符合医学伦理学规定。结果以右上腹疼痛为主要症状者9例,右上腹饱胀不适者4例。血清癌抗原(CA)19-9升高者4例,癌胚抗原(CEA)升高者3例。患者行超声和计算机体层摄影术(CT)检查,明确诊断,接受左半肝切除术2例,左半肝切除+肝Ⅷ段部分切除术1例,肝左外叶切除术3例,肝左内叶囊性肿瘤切除术1例,肝Ⅳ段切除术2例,肝Ⅳ段囊性肿瘤切除术1例;右半肝切除+胆总管囊肿切除+左肝管-空肠Roux-en-Y吻合术1例,肝Ⅵ、Ⅶ段囊性肿瘤切除术1例,肝Ⅴ、Ⅷ段囊性肿瘤切除术1例。13例患者大体标本示肿瘤直径1～14 cm,中位直径9 cm;囊壁厚薄不均,内壁不光滑,3例有明显乳头状突起物;9例囊内容物呈灰白色胶冻样液体,4例合并肝内胆管结石,3例合并胆管壁慢性炎症。术后病理学检查证实黏液性囊腺瘤3例,黏液性囊腺癌9例,部分呈交界性的黏液性囊腺瘤1例。本组无手术死亡病例,13例患者均获随访,随访时间1～72个月,中位时间35个月,随访期间无肿瘤复发。结论肝内胆管囊性肿瘤包括囊腺瘤和囊腺癌,患者无特异性临床表现,临床确诊主要根据病理学检查结果。一旦发现肝内胆管囊性肿瘤,应早期手术,其预后较好。Objective To investigate the clinical diagnostic and treatment characteristic and efficacy of hepatobiliary cystic neoplasms. Methods Clinical data of 13 patients with hepatobiliary cystic neoplasms in Department of Hepatobiliary Surgery, the Affiliated Hospital of Medical College, Qingdao University from January 2001 to March 2013 were analyzed retrospectively. There were 1 male and 12 females with age from 45 to 75 years old and a median of 55 years old. The informed consents of all patients were obtained and the ethical committee approval was received. Results Nine patients were observed with a main symptom of abdominal pain in the right upper quadrant, 4 patients with discomfort upper abdominal fullness, 4 patients with elevated serum cancer antigen （CA） 19-9 and 3 patients with elevated serum carcinoembryonic antigen （CEA）. All patients received ultrasonography and computed tomography （CT） examination and the diagnosis was confirmed. Two cases received left hemihepatectomy, 1 case received left hemihepatectomy ＋ hepatic partial resection of segment VI~, 3 cases received hepatic left lateral lobectomy, 1 case received hepatic left medial lobar cystic neoplasms resection, 2 cases received hepatic resection of segment IV, 1 case received hepatic cystic neoplasms resection of segment IV, 1 casereceived right hemihepatectomy ＋ choledochal cyst resection ＋ left hepatic duct-jejunum Roux-en-Y anastomosis, 1 case received hepatic cystic neoplasms resection of segment VI and VII, and 1 case received hepatic cystic neoplasms resection of segment Vand vm. The tumor diameter of gross specimen of 13 patients was from 1 to 14 cm with a median of 9 cm. The cyst wall thickness was not uniform and the inner wall was not smooth. Obvious papillary protrusion was observed in 3 cases. Offwhite gel-like liquid was observed inside the cysts of 9 cases. Four cases were combined with intrahepatic cholelithiasis, and 3 cases were combined with chronic inflammation in bile duct wall. Postoperative pathology examinati

关 键 词：胆管 肝内 胆管肿瘤 囊腺癌 囊腺瘤 肝切除术 病理学 外科 

分 类 号：R735.8[医药卫生—肿瘤]