肝胆管结石合并肝脓肿和胆管癌：附14例报告

Hepatolithiasis complicated by liver abscess and cholangiocarcinoma: a report of 14 cases

摘要:

目的：探讨肝胆管结石合并肝脓肿和胆管癌的诊断和治疗方法。
方法：对2004年7月—2009年12月收治的14例肝胆管结石并肝脓肿和胆管癌的临床资料进行回顾性分析。
结果：全组肝胆管结石并肝脓肿和胆管癌的发生率为0.58%（14/2 432），术前确诊5例（5/14，35.7%）；另术中快速病检发现7例，术后病检发现2例。肿瘤切除7例（7/14，50.0%）。随访的5例行肿瘤切除者生存期均超过1年，其中1例存活5年3个月；4例非切除性姑息性手术分别存活1，6，7，13个月。
结论：有多年肝胆管结石病史患者合并肝脓肿时要考虑胆管癌的可能。早期诊断及早行肿瘤根治切除是提高疗效的关键。

Abstract:

Objective：To explore the diagnosis and treatment of hepatolithiasis complicated by both liver abscess and cholangiocarcinoma.
Methods：Fourteen patients with hepatolithiass complicated by both liver abscess and cholangiocarcinoma admitted from July 2004 to September 2009 were retrospectively analyzed.
Results：The cases complicated by both liver abscess and cholangiocarcinoma accounted for 0.58% (14/2432) of the hepatolithiasis patients admitted during the same period.  Five cases were diagnosed before operation (5/14, 35.7%), 7 cases were detected by intraoperative  pathological examination and 2 cases were identified by the postoperative final pathological diagnosis. The tumor resection rate was 50.0% (7/14). At follow-up period, all the 5 patients who underwent tumor resection survived more than 1 year and 1 patient survived for 5 years and 3 months after operation; but 4 patients who underwent non-resective palliative surgery survived for 1 month, 6, 7 and 13 months, respectively.
Conclusions：Cholangiocarcinoma should be considered in patients who have a history of hepatolithiasis for many years and complicated by liver abscess. Early diagnosis and aggressive surgical resection are crucial for improving the outcomes in these patients.