肝内胆管囊腺癌28例临床分析  

Clinical analysis of 28 cases of intrahepatic biliary cystadenocarcinoma

作　　者：唐旭昇 高胜强 孔来法 TANG Xusheng;GAO Shengqiang;KONG Laifa(Department of Emergency,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua 321000,China;Department of Hepatobiliary and Pancreatic Surgery,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua 321000,China)

机构地区：[1]浙江大学医学院附属金华医院急诊科,浙江金华321000 [2]浙江大学医学院附属金华医院肝胆胰外科,浙江金华321000

出　　处：《腹腔镜外科杂志》2024年第6期430-434,共5页Journal of Laparoscopic Surgery

摘　　要：目的:总结肝内胆管囊腺癌的临床特点及诊治方法。方法:回顾分析2001年1月至2022年12月经病理证实的28例肝内胆管囊腺癌患者的临床资料、影像学特征、实验室检查结果、手术方法及预后情况。患者入院后常规行全腹部增强CT或上腹部增强磁共振检查,16例无临床症状,9例上腹部胀痛,3例皮肤巩膜黄染。结果:术前通过影像学检查诊断为肝内胆管囊腺癌9例。15例患者CA19-9升高,5例CA125升高,甲胎蛋白均正常。28例患者中8例行肿瘤局部切除术,6例行左肝外叶切除术,9例行左半肝切除术,5例行右半肝切除术。手术时间平均(205.8±30.8)min,术中出血量(210.8±45.2)mL,术后平均住院(7.6±2.1)d。术后发生5例胆漏,经保守治疗后好转。随访5~100个月,19例患者术后复发,6例死亡。结论:根据实验室检查与影像学表现,肝内胆管囊腺癌的术前诊断较困难,治疗仍以手术根治性切除为主,术后需定期复查。Objective:To summarize and discuss the clinical features,diagnosis and treatment of intrahepatic biliary cystadeno-carcinoma.Methods:The general clinical data,imaging findings,laboratory results,surgical methods and prognosis of 28 patients with intrahepatic biliary cystadenocarcinoma confirmed by pathology from Jan.2001 to Dec.2022 were retrospectively analyzed.After admis-sion,patients underwent total abdominal enhanced CT or upper abdominal enhanced magnetic resonance examination.16 patients had no clinical symptoms,9 patients suffered from upper abdominal distension and pain,and 3 patients presented with skin and sclera yellow-ing.Results:Nine cases were diagnosed as intrahepatic biliary cystadenocarcinoma by preoperative imaging examination.CA19-9 ele-vated in 15 patients,and CA125 increased in 5 patients,while AFP was normal in all patients.In 28 patients,local tumor resection was performed in 8 cases,left lateral hepatic lobectomy was performed in 6 cases,left hemihepatectomy was performed in 9 cases,and right hemihepatectomy in 5 cases.The operation time was(205.8±30.8)min,the intraoperative blood loss was(210.8±45.2)mL,and the average postoperative hospital stay was(7.6±2.1)d.Five cases of postoperative bile leakage occurred and improved after conservative treatment.Postoperative follow-up ranged from 5 to 100 months,19 patients experienced recurrence and 6 patients died.Conclusions:According to laboratory examination and imaging findings,intrahepatic biliary cystadenocarcinoma is difficult to be diagnosed before operation.Radical resection is the main treatment method,and regular follow-up is required after operation.

关 键 词：肝肿瘤 胆管囊腺癌 肝切除术 诊断 治疗 

分 类 号：R657.3[医药卫生—外科学]