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目的探讨肝外胆管癌的诊断程序,提高其诊疗水平。方法对1995年6月至2004年10月206例经手术证实的肝外胆管癌进行回顾性分析。结果(1)肝外胆管癌初诊时多以黄疸为首发症状,其他常见症状依次有上腹部隐痛(49.5%)、乏力(30.6%)、消瘦(27.2%)、厌食(13.1%)。(2)实验室检查碱性磷酸酶(AKP),γ-谷氨酰转移酶(γ-GT),糖类抗原(CA19-9)阳性率分别为100%(206/206)、93.7%(193/206)和68.4%(140/206)。(3)影像学检查中联合B超+CT、血管造影(CTA)+磁共振胰胆管成像(MRCP)+逆行性胰胆管造影(ERCP)或经皮肝穿刺胆管造影(PTC)对肝外胆管癌的确诊率为100%,2例早期胆管癌均是通过ERCP确诊的。结论建立规范的肝外胆管癌诊断程序,是改善肝外胆管癌愈后的关键。
Objective To investigate the diagnostic procedure of extrahepatic cholangiocarcinoma and improve the diagnosis and treatment of extrahepatic cholangiocarcinoma. Methods A retrospective analysis of 206 surgically-proven extrahepatic cholangiocarcinomas between June 1995 and October 2004 was performed. Results (1) Extrahepatic cholangiocarcinoma had jaundice as the first symptom when it was first diagnosed. Other common symptoms were upper abdominal pain (49.5%), fatigue (30.6%), weight loss (27.2%) and anorexia (13.1%). (2) The positive rates of alkaline phosphatase (AKP), γ-glutamyl transferase (γ-GT) and carbohydrate antigen (CA19-9) in laboratory were 100% (206/206) and 93.7% 193/206) and 68.4% (140/206). (3) Radiography combined with B ultrasound + CT, CTA + MRCP + ERCP or PTC showed that the extrahepatic bile duct The diagnosis of cancer was 100%, and 2 cases of early cholangiocarcinoma were confirmed by ERCP. Conclusion Establishing a standardized diagnostic procedure for extrahepatic cholangiocarcinoma is the key to improve the prognosis of extrahepatic cholangiocarcinoma.