Nakeeb A, Lipsett P A, Lillemoe K D, Fox-Talbot M K, Coleman J, Cameron J L, Pitt H A
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Am J Surg. 1996 Jan;171(1):147-52; discussion 152-3. doi: 10.1016/S0002-9610(99)80090-7.
Cholangiocarcinoma develops in 5% to 15% of patients with choledochal cysts, sclerosing cholangitis, and intrahepatic stones. The detection of cholangiocarcinoma in patients with premalignant biliary conditions has been difficult. Serum levels of carcinoembryonic antigen (CEA) have been neither sensitive nor specific for the diagnosis of cholangiocarcinoma. However, CEA has been shown to be present in cholangiocarcinomas by immunohistochemical staining. Therefore, we measured the level of CEA excreted in bile in patients with benign strictures, premalignant biliary diseases, and cholangiocarcinoma.
Bile was obtained from transhepatic stents in patients with benign biliary strictures (34), choledochal cysts (5), primary sclerosing cholangitis (6), intrahepatic cholelithiasis (5), and perihilar cholangiocarcinoma (25). Samples were analyzed for CEA using a solid phase, two-site immunoenzymetric assay.
Biliary CEA levels were significantly elevated (P < 0.01) in patients with cholangiocarcinoma (50.2 +/- 5.8 ng/mL) and intrahepatic cholelithiasis (57.4 +/- 10.4 ng/mL) compared with patients with benign strictures (10.1 +/- 3.9 ng/mL). Patients with sclerosing cholangitis (21.6 +/- 3.9 ng/mL) and choledochal cysts (20.0 +/- 16.5 ng/mL) had intermediate levels. In 5 patients undergoing resection of perihilar cholangiocarcinomas, the mean biliary CEA level decreased from a preoperative level of 46.8 +/- 6.7 ng/mL to a postoperative level of 11.3 +/- 5.6 ng/mL (P < 0.02). In 4 patients with progression of cholangiocarcinoma, biliary CEA increased from a mean of 53.3 +/- 6.9 ng/mL to 98.3 +/- 12.2 ng/mL (P < 0.02) over a mean interval of 9.5 months.
Increased levels of CEA can be detected in the bile of patients with chlolangiocarcinoma. Monitoring these levels may have a role in the management of cholangiocarcinoma as well as premalignant biliary conditions such as choledochal cysts and sclerosing cholangitis.
胆管癌在5%至15%的胆总管囊肿、硬化性胆管炎及肝内胆管结石患者中发生。在癌前胆道疾病患者中检测胆管癌一直很困难。癌胚抗原（CEA）血清水平对胆管癌诊断既不敏感也不特异。然而，免疫组化染色显示CEA存在于胆管癌中。因此，我们检测了良性狭窄、癌前胆道疾病及胆管癌患者胆汁中CEA的水平。
从患有良性胆道狭窄（34例）、胆总管囊肿（5例）、原发性硬化性胆管炎（6例）、肝内胆管结石（5例）及肝门周围胆管癌（25例）患者的经肝支架获取胆汁。使用固相双位点免疫酶测定法分析样本中的CEA。
与良性狭窄患者（10.1±3.9 ng/mL）相比，胆管癌患者（50.2±5.8 ng/mL）及肝内胆管结石患者（57.4±10.4 ng/mL）的胆汁CEA水平显著升高（P<0.01）。硬化性胆管炎患者（21.6±3.9 ng/mL）及胆总管囊肿患者（20.0±16.5 ng/mL）的胆汁CEA水平处于中间值。在5例行肝门周围胆管癌切除术的患者中，胆汁CEA平均水平从术前的46.8±6.7 ng/mL降至术后的11.3±5.6 ng/mL（P<0.02）。在4例胆管癌进展患者中，胆汁CEA在平均9.5个月的时间内从平均53.3±6.9 ng/mL升至98.3±12.2 ng/mL（P<0.02）。
胆管癌患者胆汁中可检测到CEA水平升高。监测这些水平可能在胆管癌以及胆总管囊肿和硬化性胆管炎等癌前胆道疾病的管理中发挥作用。
