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目的提高对肝门胆管癌诊断和鉴别诊断的认识,减少对其误诊误治。方法对上海中山医院1993年1月至1996年12月收治的33例术前诊断为肝门胆管癌的手术病例进行回顾性分析,根据病理结果,探讨影像学检查、肿瘤相关抗原、组织活检和细胞学检查以及手术探查对肝门胆管癌诊断和鉴别诊断的价值。结果根据病理结果,33例手术病例中有8例系其他肝门部梗阻性疾病被误诊为肝门胆管癌,误诊率占所有手术的24.2%。这8例被误诊患者中,包括肝门胆管癌栓3例,特发性良性狭窄2例,胆囊管癌累及肝总管1例,胆囊管残株癌1例,肝外胆管结核1例。结论虽然有较多的方法可用于肝门胆管癌的鉴别诊断,但临床误诊率仍较高。我们建议对所有肝门胆管癌病人,只要无手术禁忌证,均应积极手术探查。
Objective To improve the understanding of diagnosis and differential diagnosis of hilar cholangiocarcinoma and reduce misdiagnosis and mistreatment. Methods A retrospective analysis of 33 cases of surgical diagnosis of hilar cholangiocarcinoma from January 1993 to December 1996 in Shanghai Zhongshan Hospital was performed. Imaging findings, tumor-associated antigens, biopsy and biopsy were investigated based on pathological findings. The value of cytology and surgical exploration in the diagnosis and differential diagnosis of hilar cholangiocarcinoma. Results According to the pathological results, 8 out of 33 surgical cases were misdiagnosed as hilar cholangiocarcinoma in other hilar obstructive diseases. The misdiagnosis rate accounted for 24.2% of all surgeries. Of the 8 cases misdiagnosed, 3 cases were hilar cholangiocarcinoma, 2 cases were idiopathic benign stenosis, 1 case involved cystic duct carcinoma, 1 case of hepatic tract, 1 case of cystic duct stump cancer, and 1 case of extrahepatic bile duct tuberculosis. Conclusion Although there are more methods for the differential diagnosis of hilar cholangiocarcinoma, the misdiagnosis rate in clinic is still high. We recommend that all patients with hepatic hilar cholangiocarcinoma should undergo proactive surgical exploration as long as they have no surgical contraindications.