无黄疸期肝外胆管癌的诊治体会

摘要

Objective To determine whether there is a difference in diagnosisand treatment of extrahepatic bile duct carcinoma between the patients with jaundice and those without. Methods The data of 86 patients with extrahepatic bile duct carcinoma treated in our Department from January 1984 to December 1998 were retrospectively analyzed. The patients were divided into the jaundiced group (n=72) and non-jaundiced one (n=14) according to the preoperative level of serum total bilirubin. Then the clinical manifestations, biochemical examination, location of the tumor and pathological and surgical resection were compared between the 2 groups. Results About 16% of the extrahepatic bile duct carcinoma was diagnosed before jaundice. The number of patients with complication of choloelithiasis was markedly higher in the non-jaundiced group than in the jaundiced one. Conclusions With or without jaundice is not a standard to evaluate the prognosis of extrahepatic bile duct carcinoma. Before jaundice, extrahepatic bile duct carcinoma does have some clinical manifestations that can help us in diagnosis of the tumor before the appearance of jaundice.%目的 了解未出现黄疸的肝外胆管癌在诊治方面与有黄疸者有无差别。方法 回顾性地总结了湖南医科大学附属湘雅医院外科1984年元月至1998年12月经手术治疗的86例肝外胆管癌。按术前血清总胆红素水平分为黄疸组与无黄疸组。分别了解其临床表现，生化检查、影像学检查、肿块部位、病理分型及手术切除情况。结果 在没有明显手术禁忌证的肝外胆管癌中无黄疸期肝外胆管癌占本组总数的16.2%；在无黄疸组各种生化指标(如HB，ALB，AKP，γ-GT等)及B超检查已有与黄疸组类似的改变，而且两组肝外胆管癌的肿块部位，病理类型及手术切除率亦无显著差异；无黄疸期肝外胆管癌结石合并率较黄疸期者明显为高。结论 不能单纯依靠有无黄疸而对肝外胆管癌的进展程度及预后进行评价和预测应提高对此疾病的警惕，以便及早发现病变。