肝内胆管结石患者的胆管细胞癌取决于肝内结石的类型。

Chijiiwa Kazuo, Ohtani Kazuhiro, Noshiro Hirokazu, Yamasaki Toru, Shimizu Shuji, Yamaguchi Koji, Tanaka Masao

Department of Surgery 1, Kyushu University Faculty of Medicine, Fukuoka, 812-8582, Japan.

Hepatogastroenterology. 2002 Jan-Feb;49(43):96-9.

BACKGROUND/AIMS: Association of cholangiocellular carcinoma in patients with hepatolithiasis has been reported. However, its incidence depending on the kind of stones is obscure. The aim was to examine the association rate of cholangiocellular carcinoma in patients with hepatolithiasis with a special reference to the kind of intrahepatic stones.

METHODOLOGY

One hundred and thirty-nine patients with hepatolithiasis who have been treated from 1973 to 1997 were retrospectively reviewed to examine the characteristics of cholangiocellular carcinoma. The type and location of intrahepatic calculi were analyzed.

RESULTS

Cholangiocellular carcinoma was found in 8 of 139 patients, the incidence being 5.8%. The incidence of carcinoma was more than twice in patients whose stones were located in intrahepatic bile duct only (9.3%; 5/54) than in those located in both intrahepatic and extrahepatic bile duct (3.5%; 3/85). Of 121 patients excluding 18 whose calculi were not available for classification, the kind of intrahepatic calculi was brown pigment in 106 patients (87.6%), cholesterol in 10 (8.3%), black pigment in 4, and fatty acid calcium in one. Cholangiocellular carcinoma was associated in 3 (2.8%) of 106 patients with brown pigment stones, 3 (30%) of 10 with cholesterol stones, in one with fatty acid calcium stones, and one patient whose stone was not available for analysis. The association rate of cancer was significantly (P < 0.01) higher in patients with cholesterol stones than those with brown pigment stones. One patient survived for 24 months after left lobectomy but the others died within six months.

CONCLUSIONS

An early and attentive evaluation for the possible presence of cholangiocellular carcinoma is mandatory not only in patients with brown pigment stones but also in those with intrahepatic cholesterol stones.

背景/目的：已有报道称肝内胆管结石患者与胆管细胞癌有关联。然而，其发病率与结石类型的关系尚不清楚。本研究旨在特别参照肝内结石的类型，探讨肝内胆管结石患者中胆管细胞癌的关联率。

方法

回顾性分析1973年至1997年间接受治疗的139例肝内胆管结石患者，以研究胆管细胞癌的特征。分析肝内结石的类型和位置。

结果

139例患者中有8例发现胆管细胞癌，发病率为5.8%。结石仅位于肝内胆管的患者中癌的发病率（9.3%；5/54）是结石位于肝内和肝外胆管两者的患者（3.5%；3/85）的两倍多。在121例可对结石进行分类的患者中（排除18例结石无法分类的患者），106例患者（87.6%）的肝内结石类型为棕色色素结石，10例（8.3%）为胆固醇结石，4例为黑色色素结石，1例为脂肪酸钙结石。106例棕色色素结石患者中有3例（2.8%）发生胆管细胞癌，10例胆固醇结石患者中有3例（30%）发生，1例脂肪酸钙结石患者发生，1例结石无法分析的患者发生。胆固醇结石患者的癌症关联率显著高于棕色色素结石患者（P<0.01）。1例患者左叶切除术后存活24个月，但其他患者均在6个月内死亡。