Chu K M, Lo C M, Liu C L, Fan S T
Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Hepatogastroenterology. 1997 Mar-Apr;44(14):352-7.
BACKGROUND/AIMS: Malignancy is known to be associated with hepatolithiasis. The present report summarizes the results of our management of patients with cholangiocarcinoma associated with hepatolithiasis.
Twenty patients with cholangiocarcinoma and associated hepatolithiasis were analyzed retrospectively. There were 12 males and 8 females, with a mean age of 59.3 years. The clinical records of these patients were reviewed to determine demographic characteristics, clinical features, laboratory findings, diagnostic tests, operative management and results of therapy.
One patient was moribund on presentation and was treated conservatively. Fourteen patients underwent hepatic resection. Three of them had palliative resection. Hepatic resection was less likely to be performed in patients having right lobe disease (50%) as compared to patients having left lobe disease (90%) (p = NS). The overall operative morbidity and mortality rates after hepatic resection were 36% and 7%, respectively. Non-resective operations were performed in five patients. The overall operative morbidity and mortality rates after non-resective operations were 20% and 0%, respectively. After curative hepatic resection (11 patients), the 1- and 2-year survival rates were 81% and 51%, respectively.
A suspicion of malignancy is necessary in managing patients with hepatolithiasis. Hepatic resection is the treatment of choice for cholangiocarcinoma when it is resectable.
背景/目的：已知恶性肿瘤与肝内胆管结石有关。本报告总结了我们对肝内胆管结石合并胆管癌患者的治疗结果。
回顾性分析20例胆管癌合并肝内胆管结石患者。其中男性12例，女性8例，平均年龄59.3岁。回顾这些患者的临床记录，以确定人口统计学特征、临床特征、实验室检查结果、诊断测试、手术治疗及治疗结果。
1例患者就诊时已奄奄一息，接受了保守治疗。14例患者接受了肝切除术。其中3例为姑息性切除。与左叶疾病患者（90%）相比，右叶疾病患者（50%）进行肝切除的可能性较小（p=无显著性差异）。肝切除术后的总体手术发病率和死亡率分别为36%和7%。5例患者接受了非切除手术。非切除手术后的总体手术发病率和死亡率分别为20%和0%。根治性肝切除术后（11例患者），1年和2年生存率分别为81%和51%。
在处理肝内胆管结石患者时，有必要怀疑存在恶性肿瘤。对于可切除的胆管癌，肝切除术是首选的治疗方法。
