目的 探讨肝内胆管结石合并肝内胆管癌的诊治体会。方法 对比观察21例肝内胆管结石合并肝内胆管癌患者术前血清CA199、CEA值,贫血程度,肝内胆管结石病程等对诊断,以及不同治疗方法对患者预后的影响。结果 血清CA199在合并肿瘤组阳性检出率明显高于单纯肝内胆管结石组(71.43%对16.67%,P=0.001);CEA在合并肿瘤组检出率也明显高于单纯肝内胆管结石组检出率(14.29%对0%,P=0.001);另外在合并肿瘤组,贫血程度明显高于单纯肝内胆管结石组(<10 g/L;66.67%对20.0%,P=0.001),胆管结石病程也明显长于单纯肝内胆管结石组(17.62年对11.30年,P=0.001)。在治疗方面,规则性半肝切除加肝门淋巴结清扫术的患者存活时间长于局部切除加肝门淋巴结清扫(31.67个月对17.4个月,P=0.042)。结论 对于肝内胆管结石患者应重视CA199、CEA、血红蛋白检测和胆石病程的观察,以利于术前判断是否合并肝内胆管癌;对于肝内胆管结石合并肝内胆管癌的治疗,规则性半肝切除加肝门淋巴结清扫术应作为首选的手术。

Objective To discuss the diagnosis and treatment for stone and carcinoma of intrahepatic bile duct.Methods This article analyzed the effect of serum CA199,CEA,anemia degree,and intrahepatic bile duct stone course on diagnosis and the effect of different surgical Methods on prognosis of patients with stone and/or carcinoma of intrahepatic bile duct.Results In carcinoma + stone group,serum CA199 (71.43% vs.16.67%,P=0.001) and CEA (14.29% vs.0%,P=0.001) levels were higher than those of stone group; anemia degree was more serious (<10 g/L,66.67% vs.20.0%,P=0.001); the course of intrahepatic bile duct stone was longer (17.62 vs.11.30 years,P=0.001).The patients who received half liver resection with lymph node cleaning of hilus had a longer survival time compared with the patients who received local resection with lymph node cleaning of hilus (31.67 vs.17.4 months,P=0.042). Conclusion Observation of serum CA199,CEA,hemoglobin,and stone course in patients with intrahepatic bile duct stone may help diagnose whether intrahepatic bile duct carcinoma is combined.In addition,half liver resection with lymph node cleaning of hilus is recommended to patients with intrahepatic bile duct stone combined with intrahepatic bile duct carcinoma.