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1952年Sanes首先报告2例肝内胆管结石伴胆管癌以来,有关其术前诊断仍很困难.作者在过去21年中共收治肝内胆管结石113例,其中103例为单纯结石(H组),10例伴发胆管癌(C组),分析结果如下:(一)病人 在H组,男女之比为1:1.6,而C组则为1:0.7.H组主要症状为腹痛(87%)、发热(65%)和黄疸(51%)而C组主要为腹痛(90%)、发热(80%)和黄疸(20%).H组和C组的病程分别为12年(3天～40年)和13年(3月～27年).(二)化验检查 两组的血常规和肝功能无明显差异.40例H组和9例C组病人作了癌胚抗原测定(CEA),测定值超过正常者分别占18%和67%(p<0.01),CEA诊断胆管癌的敏感性为67%,特异性为83%,如取CEA值超过正常2倍列为异常,则其敏感性为93%.19例H组和1例C组病人测定CA19-9,分别有3例和1例超过正常值.(三)肝内胆管结石的分类 见下表所示,左侧肝叶胆管结石伴发胆管癌达18%(8/45).在H组中,33例无胆管狭窄,70例有狭窄,其中2处8例和3处2例;在C组中,1例无狭窄,狭窄位于左肝管6例、左叶胆管2例和右叶后段1例.可见在80%胆管癌中,狭窄位于左叶.狭窄的位置与胆管癌的部位相符合.
In 1952, Sanes first reported 2 cases of intrahepatic bile duct stones with cholangiocarcinoma, the preoperative diagnosis is still very difficult. The authors treated 113 cases of intrahepatic bile duct stones in the past 21 years, 103 cases of simple stones (H group), In 10 patients with cholangiocarcinoma (C), the results were as follows: (1) In the H group, the ratio between males and females was 1:1.6, while in the C group was 1:0.7. The main symptom in the H group was abdominal pain (87%). , Fever (65%) and Astragalus membranaceus (51%), while in group C, abdominal pain (90%), fever (80%), and astragalus (20%) were the main symptoms. The duration of H and C groups was 12 years (3 days~ 40 years) and 13 years (March to 27 years). (II) Laboratory tests showed no significant difference in blood routine and liver function between two groups. Forty patients with H and 9 patients with C were examined for carcinoembryonic antigen (CEA). 18% and 67% (p<0.01) of the measured values exceeded the normal level. The sensitivity of CEA in the diagnosis of cholangiocarcinoma was 67%, and the specificity was 83%. If the CEA value was more than 2 times normal, it was abnormal. Sensitivity was 93%. CA19-9 was measured in 19 patients in group H and 1 patient in group C. There were 3 cases and 1 case exceeding normal values. (3) Classification of intrahepatic bile duct stones is shown in the table below. Bile duct stones with bile duct cancer up to 18% (8/45). In group H, 33 cases had no bile duct stenosis, 70 cases had stenosis, 2 of them 8 cases and 3 cases of 2 cases; in group C, 1 case was not stricture, and the stenosis was located in 6 cases of left hepatic duct, 2 cases of left bile duct, and 1 case of posterior right lobe. In 80% of cholangiocarcinoma, the stenosis was located in the left The position of the stenosis is consistent with the location of the bile duct cancer.