末梢型肝内胆管细胞癌的诊断及外科治疗效果分析

目的 探讨末梢型肝内总胆管细胞癌（PIHCC）的诊断及外科治疗结果，以提高其诊治水平。方法 回顾性分析1970－1999年间外科治疗的20例PIHCC患者诊断、治疗及预后的资料。结果 （1）本病缺乏特异性临床表现，部分病例可并发乙型肝炎（35．0％）、肝硬化（45．0％）和血清AFP升高（25．0％）；（2）影像学检查：B超、CT、MRI及ECT的诊断率分别为90．0％（18／20）、94．4％（17／18）、3／3及4／3；（3）手术切除率为60％，全组病例的1、3、5年生存率分别为55．0％（11／20）、35．0％（7／20）及20．0％（4／20），其中肝切除术病例分别为83．3％（11／12）、58．3％（7／12）、33．3％（4／12）；（4）生存5年以上的4例患者中，直径≤3cm的小肝癌3例、包膜完整的结节型大肝癌1例，且术后均辅助选择性肝动脉灌注化疗，有助于生存率的提高。结论 本病缺乏特异性血清肿瘤标志物,治愈性切除术（包括术后辅助治疗）可获得良好生存率。

Diagnosis and surgical treatment of peripheral intrahepatic cholangiocarcinoma

Objective To summarize the experience in diagnosis and surgical treatment of peripheral intrahepatic cholangiocarcinoma (PICC). Methods Clinicopathological features, surgical treatment and prognosis of 20 patients with PICC treated in our hospital from 1970 to 1999 were retrospectively analyzed. Results The patients lacked typical clinical manifestations and some had a history of hepatitis B (35%), cirrhosis (45%), and elevation of serum alpha-fetaprotein (AFP) (25%). The diagnostic rates of ultrasound examination (BUS), CT, MRI and emission computerized tomography (ECT) were 90% (18/20), 94% (17/18), 100% (3/3) and 100% (4/4), respectively. However, the liver lesions detected by these methods needed to be differentiated from hepatocellular carcinoma (HCC), metastatic neoplasm and liver cyst, etc. In all the patients, the resection rate was 60% (12/20) and postoperative overall 1 , 3 and 5 year survival rates were 55% (11/20), 35% (7/12) and 20% (4/20), respectively. The liver resection rates were 83% (11/12), 58% (7/12) and 33% (4/12), respectively. Of the 4 patients who had survived for more than 5 years, 3 had a small liver carcinoma with a diameter less than or equal to 3 cm and one had large nodular liver carcinoma with intact capsule. After operation, all the patients received selective hepatic artery perfusion chemotherapy. Conclusion PICC patients lack specific serum tumor marker can achieve good survival after early detection and curative resection with adjuvant therapies.