淋巴上皮瘤样肝内胆管癌诊断与治疗的临床分析  

Clinical analysis of the diagnosis and treatment of lymphoepithelioma-like intrahepatic cholangiocarcinoma

作　　者：周擎云 涂朝勇[1] 吕昕亮[1] 张敏[2] 杨文策 张坤[1] Zhou Qingyun;Tu Chaoyong;Lyu Xinliang;Zhang Min;Yang Wence;Zhang Kun(Department of Hepatobiliary and Pancreatic Surgery,Lishui Central Hospital,Lishui 323000,China;Department of Pathology,Lishui Central Hospital,Lishui 323000,China;Department of Surgery,Lishui City Liandu District People's Hospital,Lishui 323006,China)

机构地区：[1]浙江省丽水市中心医院肝胆胰外科,丽水323000 [2]浙江省丽水市中心医院病理科,丽水323000 [3]浙江省丽水市莲都区人民医院外科,丽水323006

出　　处：《国际外科学杂志》2024年第4期260-265,F0004,共7页International Journal of Surgery

基　　金：丽水市科技计划项目(2022ZDYF08)。

摘　　要：目的探讨淋巴上皮瘤样肝内胆管癌(LEL-ICC)的诊断与治疗策略。方法采用回顾性描述性研究的方法收集浙江省丽水市中心医院2009年12月1日-2024年1月30日7例肝切除术后病理确诊为LEL-ICC患者的临床资料, 其中男性2例, 女性5例;年龄为40~64岁, 中位年龄52岁;7例患者均无明显临床症状。分析患者的影像学表现、病理特征、治疗方式及预后情况等。术后采用电话随访, 随访内容为患者是否存在复发, 随访截止日期为2024年2月20日。结果 5例患者接受超声检查, 其中4例表现为低回声, 1例表现为强回声;7例接受磁共振检查, 表现为T1WI低信号、T2WI高信号及弥散加权成像呈高信号, 其中A型强化2例, B型强化2例, C型强化3例;7例均接受外科手术治疗, 2例术后接受预防性经导管动脉化疗栓塞, 3例术后接受全身化疗;7例均进行术后随访, 随访时间为1~166个月, 随访中位时间为56个月。1例术后5个月出现肝门部及腹膜后淋巴结转移行手术治疗, 术后行全身化疗, 25个月后再次出现右侧肾上腺转移, 经综合治疗转移灶缩小后行手术治疗及全身化疗, 目前无复发。其余6例均无复发。结论 LEL-ICC缺乏特异性临床症状及影像学表现, 需依靠组织病理学和免疫组织化学检查确诊。以外科手术为主的综合治疗可使患者获得较好的预后。Objective To explore the diagnosis and treatment of lymphoepithelioma-like intrahepatic cholangiocarcinoma(LEL-ICC).Methods The retrospective and descriptive study was conducted.The data of 7 patients with pathological diagnosis of LEL-ICC after hepatectomy who were treated in Lishui Central Hospital in Zhejiang Province from December 1,2009 to January 30,2024 were collected.There were 2 males and 5 females.The age range was from 40 to 64 years old,with a median age of 52 years old.All 7 patients showed no obvious clinical symptoms.We analysed the imaging manifestations,pathological features,treatmentsand prognoses of patients.Postoperative follow-upswere conducted via telephone,with a focus on whether the patient had relapsed.The deadline was February 20,2024.Results Five cases underwent ultrasound examination,of which 4 cases showed hypoechogenicity and 1 case showed hyperechogenicity.7 cases underwent MRI examination,showing low signal on T1WI,high signal on T2WI,and high signal on diffusion-weighted imaging.2 cases had type A enhancement,2 cases had type B enhancement,and 3 cases had type C enhancement.All 7 cases received surgical treatment,2 cases were received prophylactic transarterial chemoembolization(TACE)after surgery,and 3 cases were received systemic chemotherapy after surgery;All 7 cases underwent postoperative follow-up,with a follow-up time of 1-166 months and a median follow-up time of 56 months.One case developed hilar and retroperitoneal lymph node metastasis after surgery for 6 months,and underwent surgical treatment.After surgery,chemotherapy was performed.25 months later,right adrenal gland metastasis reappeared,and after combined treatment,the metastatic lesion was reduced and the patient received surgical treatment and chemotherapy,and there is currently no recurrence.The remaining 6 cases showed no recurrence.Conclusions LEL-ICC lacks specific clinical symptoms and imaging manifestations,diagnosis relies on histopathological and immunohistochemical examinations.Comprehensive treatment wi

关 键 词：胆管肿瘤 诊断 治疗结果 淋巴上皮瘤样肝内胆管癌 

分 类 号：R735.8[医药卫生—肿瘤]