本文選題：肝內(nèi)膽管結(jié)石　切入點：肝內(nèi)膽管癌　出處：《南昌大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過臨床資料分析肝內(nèi)膽管結(jié)石合并肝內(nèi)膽管癌的臨床特征、診斷方法、治療效果。方法:采用回顧性研究方法,收集南昌大學(xué)第一附屬醫(yī)院2010-2014年期間30例病理結(jié)果證實為肝內(nèi)膽管結(jié)石合并肝內(nèi)膽管癌患者的臨床資料。通過科室病例查詢系統(tǒng)診斷為肝內(nèi)膽管結(jié)石,并在其內(nèi)篩選出伴有肝內(nèi)膽管癌的患者,其中經(jīng)手術(shù)治療并病理學(xué)診斷為肝內(nèi)膽管細(xì)胞癌者30例,將其作為觀察組。這期間通過手術(shù)治療且術(shù)中觀察及手術(shù)病理結(jié)果證實為單純性肝內(nèi)膽管結(jié)石40例作為對照組。通過本院病例系統(tǒng)及相關(guān)科室醫(yī)療系統(tǒng)進(jìn)行相關(guān)資料的收集。結(jié)果:觀察組中肝內(nèi)膽管結(jié)石合并肝內(nèi)膽管癌術(shù)前明確診斷18例,術(shù)前的診斷率為60%。術(shù)中行快速冰凍病理明確診斷的為8例,術(shù)后病理結(jié)果明確診斷的為4例。觀察組中術(shù)前均行B超檢查,B超術(shù)前明確診斷12例,診斷率為40%。26例行CT檢查,CT術(shù)前明確診斷18例,診斷率為69.2%。21例行MRI檢查,MRI術(shù)前診斷15例,診斷率為71.4%。各檢查之間采用X~2檢驗,結(jié)果顯示CT、MRI的診斷效果明顯優(yōu)于B超,CT和MRI的診斷效果相當(dāng)。觀察組中血清CA19-9、CEA檢測值高于正常分別占86.6%、43.3%,對比組中血清CA19-9、CEA檢測值高于正常分別占7.5%%、5%,兩組間行X~2檢驗,結(jié)果表明血清CA19-9、CEA檢測值高于正常所占的比率在兩組間的差異是有統(tǒng)計學(xué)意義。手術(shù)治療中行根治性切除18例,占60%。姑息性手術(shù)8例,占26.7%,單純活檢4例。術(shù)后隨訪28例,根治性切除者平均生存21個月,姑息性治療者平均生存11個月,單純活檢者平均生存5個月。行前兩種手術(shù)方式患者的生存期之間行t檢驗,結(jié)果表明根治性切除相對姑息性治療更能延長患者的生存期。結(jié)論:B超、CT、MRI影像學(xué)檢查與血清CA19-9、CEA的檢測,對明確肝內(nèi)膽管結(jié)石合并肝內(nèi)膽管癌的診斷有較重要的價值,對術(shù)中可疑病灶應(yīng)行快速冰凍病理檢查以明確診斷,根治性手術(shù)治療相對于姑息性手術(shù)能顯著延長患者生存期。
[Abstract]:Objective: to analyze the clinical features, diagnostic methods and therapeutic effects of intrahepatic cholangiolithiasis complicated with intrahepatic cholangiocarcinoma through clinical data. The clinical data of 30 patients with intrahepatic cholelithiasis associated with intrahepatic cholangiocarcinoma were collected from the first affiliated Hospital of Nanchang University from 2010 to 2014. The patients with intrahepatic cholangiocarcinoma were selected, including 30 cases of intrahepatic cholangiocarcinoma diagnosed by operation and pathology. During this period, 40 cases of simple intrahepatic cholelithiasis were proved to be simple intrahepatic cholelithiasis by operation and pathology. Results: 18 cases of intrahepatic cholelithiasis complicated with intrahepatic cholangiocarcinoma were definitely diagnosed before operation in the observation group. The diagnostic rate was 60% before operation, 8 cases were diagnosed by rapid frozen pathology during operation, and 4 cases by pathological results after operation. All the patients in the observation group were examined by B-ultrasound before operation, 12 cases were diagnosed by B-ultrasound before operation. The diagnostic rate was 40%. 26 cases were diagnosed by CT and 18 cases were diagnosed by CT. The diagnostic rate was 69.2%. 15 cases were diagnosed before MRI, and the diagnostic rate was 71.4%. The results showed that the diagnostic effect of CTV-MRI was significantly better than that of B-ultrasound CT and MRI. In the observation group, the detection value of serum CA19-9 MRI was higher than that of the normal group (86.6%, 43.3%, respectively), and the serum CA19-9 level in the control group was higher than that in the control group (7.5%), and the X2 test was performed between the two groups. The results showed that there was significant difference between the two groups in the ratio of serum CA19-9 CEA to normal. 18 cases (60%) underwent radical resection, 8 cases (26.7%) palliative operation, 4 cases simple biopsy, and 28 cases were followed up. The average survival was 21 months for radical resection, 11 months for palliative therapy and 5 months for simple biopsy. The results showed that radical resection was more effective than palliative treatment in prolonging the survival time of patients. Conclusion: MRI and serum CA19-9 CEA are important for the diagnosis of intrahepatic cholelithiasis with intrahepatic cholangiocarcinoma. Rapid frozen pathological examination should be performed for the diagnosis of suspicious lesions during operation. Radical operation can significantly prolong the survival time of patients compared with palliative operation.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.8;R575.62

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