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目的比较肝门胆管癌(hilar cholangiocarcinoma,HCCA)与肝门部良性疾病的临床病理学特征,并探索CA19-9和癌胚抗原(CEA)对HCCA与肝门部良性疾病的鉴别诊断价值。方法回顾性分析笔者所在医院胆道外科2011年1月至2015年10月期间收治的术前诊断为HCCA并行手术治疗的65例患者的临床资料,术后经病例证实54例为HCCA,11例为肝门部良性疾病。比较HCCA患者和肝门部良性疾病患者的年龄、性别、病程、临床表现、实验室检查、影像学检查等临床资料,并采用受试者工作特征曲线(ROC曲线)分析CA19-9和CEA对HCCA与肝门部良性疾病的鉴别诊断价值。结果 HCCA组患者的年龄,以及血清CA19-9、CEA、谷丙转氨酶(ALT)、总胆红素(BILT)和直接胆红素(BILD)水平均高于良性组(P<0.05);但2组患者的性别构成、病程、临床表现(包括黄疸、腹部不适、发热及体质量下降)、血清谷草转氨酶(AST)和碱性磷酸酶(ALKP)水平,以及各影像学表现(包括肝门肿物、肝内胆管扩张、胆管壁增厚、淋巴结肿大、血管侵犯及胆囊侵犯)比较差异均无统计学意义(P>0.05)。CA19-9和CEA的ROC曲线结果表明,CA19-9为233.15 U/m L时,灵敏度为56%,特异度为91%;CEA为2.98 ng/m L时,灵敏度为61%,特异度为90%。结论对于HCCA与肝门部良性疾病的鉴别诊断,高龄且血清转氨酶、胆红素明显升高者恶性可能性大,如果同时伴有CA19-9>233.15 U/m L、CEA>2.98 ng/m L更应警惕HCCA。
Objective To compare the clinicopathological features of hilar cholangiocarcinoma (HCC) with hilar benign diseases and to explore the differential diagnostic value of CA19-9 and carcinoembryonic antigen (CEA) in the diagnosis of HCCA and hilar benign diseases. Methods The clinical data of 65 patients undergoing preoperative diagnosis of HCCA concurrent surgical treatment admitted to our hospital from January 2011 to October 2015 were analyzed retrospectively. 54 cases were HCCA confirmed by the cases and 11 cases were Hilar benign disease. The clinical data including age, sex, course of disease, clinical manifestation, laboratory examination and imaging examination were compared between HCCA patients and patients with benign hepatic hilar diseases. The ROC curves of CA19-9 and CEA HCCA and hilar differential diagnosis of benign disease. Results The serum levels of CA19-9, CEA, ALT, BILT and BILD in HCCA group were significantly higher than those in benign group (P <0.05). However, The gender composition, course of disease, clinical manifestations (including jaundice, abdominal discomfort, fever and weight loss), serum AST and ALKP levels, and imaging findings (including hepatic Tumor, intrahepatic bile duct dilation, bile duct wall thickening, lymphadenopathy, vascular invasion and gallbladder invasion). There was no significant difference between the two groups (P> 0.05). The ROC curves of CA19-9 and CEA showed that the sensitivity was 56% and the specificity was 91% when the CA19-9 was 233.15 U / mL, the sensitivity was 61% when the CEA was 2.98 ng / mL, the specificity was 90%. Conclusions For the differential diagnosis between HCCA and hepatic hilar benign diseases, the elderly patients with high serum aminotransferase and bilirubin have a high possibility of malignancy. If the patients with CA19-9> 233.15 U / m L and CEA> 2.98 ng / m L should be more alert to HCCA.