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目的 探讨肝门部胆管癌的诊断和治疗方法。方法 术前 5 5例行B超、彩色超声、血CEA、CA19 9测定。 40例行MRI和磁共振胆道成像检查 ,采用MTT法对 2 8例行肿瘤化疗药物敏感性测定。结果 根据本组病例的资料 ,肝门部胆管癌的术前诊断可分两步进行。用B超结合临床资料对患者进行筛选 ,然后进行三项检查 :(1)血清CA19 9值测定 (>2 2 2KU/L者 39例 ) ;(2 )彩色超声 ;(3)MRI和磁共振胆道成像。如果两项以上检查结果阳性 ,则可基本确诊为肝门部胆管癌。术前诊断准确率为 93% (37/4 0 )。根治性切除组 1年、2年、3年生存率分别为 92 % (12 /13)、92 % (12 /13)和5 0 % (6 /12 ) ,而在肿瘤部分切除、联合应用镍钛记忆合金胆道内支架、区域动脉灌注化疗组则分别为6 5 % (11/17)、33% (4/12 )和 17% (1/6 )。结论 凡无手术禁忌证的患者均应开腹探查。肿瘤部分切除联合应用镍钛记忆合金胆道内支架行区域动脉灌注化疗也可取得较好的姑息治疗效果。
Objective To investigate the diagnosis and treatment of hilar cholangiocarcinoma. Methods B ultrasound, color ultrasound, blood CEA and CA19 9 were measured in 55 patients before operation. 40 routine MRI and magnetic resonance biliary tract examinations were performed. MTT assay was used to determine the susceptibility of 28 cancer chemotherapy drugs. Results According to the data of this group of patients, preoperative diagnosis of hilar cholangiocarcinoma can be performed in two steps. The patients were screened with B-ultrasound combined with clinical data and then three tests were performed: (1) serum CA19 9 (>29 2KU/L in 39 patients); (2) color ultrasound; (3) MRI and magnetic resonance imaging Biliary imaging. If the results of the two or more tests are positive, the diagnosis of hilar cholangiocarcinoma can be basically confirmed. Preoperative diagnostic accuracy was 93% (37/40). The 1-year, 2-year, and 3-year survival rates of the radical resection group were 92% (12/13), 92% (12/13), and 50% (6/12), respectively. Titanium memory alloy biliary stents and regional arterial infusion chemotherapy groups were 65% (11/17), 33% (4/12), and 17% (1/6), respectively. Conclusion Patients with no surgical contraindications should be open for exploration. The partial excision of the tumor combined with the application of nitinol-based memory alloy biliary stents for regional arterial infusion chemotherapy can also achieve better palliative treatment.