[摘要] 目的 探讨肝内胆管结石合并肝内胆管癌的临床特点、诊断和治疗方法。方法 回顾性分析收治的56例经手术病理证实的肝内胆管结石合并胆管癌的临床资料。结果 56例患者中，肝内胆管结石合并肝内胆管癌在所有肝内胆管结石的病例中占6.07%(56/923)。CA199全组检测阳性率达85.71%；术前B超、CT和MRI/MRCP对肝内胆管结石并发肝内占位病变确诊率分别为53.57%、61.710%、69.77%。手术根治切除率、姑息切除率分别为46.43%、25.00%。根治切除组1、2、3年生存率分别为92.28% ,69.23% ,53.84% ；姑息切除组1、2、3年生存率分别为35.73% ,21.41% ,0.00% ；无法切除组无一年生存率。结论 肝内胆管结石症状反复发作、血CA199阳性、合并有肝内胆管结石病史的肝脏占位对于诊断肝内胆管癌有重要价值。积极的手术切除能提高生存率。

    [关键词] 胆管上皮癌；肝内胆管结石；治疗；预后

    Clinical analysis of hepatolithiasis with intrahepatic cholangiocarcinoma in 56 cases CHEN Jianfeng, HUANG Dongsheng. Department of General Surgery, The 1st Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China

    [Abstract] Objective To explore the clinical characteristics and different diagnosis and therapeutic methods of hepatolithiasis with intrahepatic cholangiocarcinoma(ICC). Methods The clinical data of 56 patients with hepatolithiasis and intrahepatic cholangiocarcinoma were retrospectively analyzed. Follow up data were available for all the patients. Results The occurrence rate of the hapatolithiasia concomitant with intrahepatic cholangiocarcinoma was 6.07%(56/923). the positive rate of CA199 was 85.71%. In this series, the correct diagnostic rate of hepatolithiasis associated with a space-occupying lesion in the liver before operation by ultrasonograph was 53.57%, by CT was 61.70% and MRI/MRCP was 69.77%. The radical resection rate was 46.43% and the palliative resection was 25.00%. The cumulative survival rates at the 1st, 2nd and 3rd year after radical resection were 92.28%, 69.23%, and 53.84% respectively. The cumulative survival rates at the 1st, 2nd and 3rd year after palliative resection were 35.73%, 21.41% and 0.00% respectively. There was no 1 year cumulative survival rate in non-operation patients. Conclusion Long-term recurrent hepatolithiasis, postoperation of biliary tract cholidocholithisis with intrahepatic mass, positive CA199 are helpful for the diagnosis of intrahepatic cholangiocarcinoma. Operative removal can improve the survival rate. ......