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目的总结肝内胆管囊腺癌的临床特点及诊治经验。方法回顾性分析中国医学科学院肿瘤医院1999年1月至2011年10月手术切除并病理证实的肝内胆管囊腺癌6例病人的临床资料。结果病人主要临床表现为非特异性症状,如右上腹不适等或缺乏明显症状。4例出现血CA19-9升高。1例术后病理证实区域淋巴结转移,术后8个月发现肝内多发转移并于术后10个月死亡;另1例外科切缘不足5mm,术后6个月肝内多发转移及骨转移,在外院行全身化疗后疾病进展,术后21个月死亡;其余4例无瘤生存至今。结论 CA19-9升高、B超和增强CT扫描有助于鉴别肝内胆管囊腺癌和其他肝内囊性病变并提高诊断率。手术切除是其根治的首选治疗,保证充分的外科切缘可减少肝内复发并明显延长生存期,伴有区域淋巴结转移可能是影响预后的重要因素之一。
Objective To summarize the clinical features and diagnosis and treatment of intrahepatic cholangiocarcinoma. Methods The clinical data of 6 patients with intrahepatic cholangiocarcinoma confirmed by surgery and pathology from January 1999 to October 2011 in Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively analyzed. Results The main clinical manifestations of patients with non-specific symptoms, such as right upper quadrant discomfort or lack of obvious symptoms. 4 cases of blood CA19-9 increased. One case of postoperative pathology confirmed regional lymph node metastasis, multiple intrahepatic metastases were found 8 months after the operation and died 10 months after the operation; the other one case of surgical margin less than 5mm, 6 months after intrahepatic multiple metastasis and bone metastasis , The disease progressed after systemic chemotherapy in the external hospital and died after 21 months. The remaining 4 patients had no tumor to date. Conclusion CA19-9 increased, B-ultrasound and enhanced CT scan can help identify intrahepatic cholangiocarcinoma and other intrahepatic cystic lesions and improve the diagnosis rate. Surgical resection is the first choice of radical mastectomy. Ensuring sufficient surgical margins can reduce intrahepatic recurrence and prolong the survival time significantly. Associated with regional lymph node metastasis may be one of the important factors that affect the prognosis.