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目的探求实用和有效的诊断肝门胆管癌的方法。方法对61例肝门胆管癌及50例良性胆道疾病(肝内胆管结石伴肝管狭窄、肝门胆管损伤性狭窄)的临床表现、实验室和影像检查结果比较分析。结果肝门胆管癌的主要表现为梗阻性黄疸和右上腹痛。肝门胆管癌病人血清CAl9—9水平显著高于良性对照组(P<0.01)。血清 CA19-9,CEA诊断肝门胆管癌的敏感性和特异性分别是83.6%,17.4%和68%,100%。B 超,电脑彩超,CT,MRI 诊断肝门胆管癌的敏感性和特异性分别是7O%,97.9%,71.9%,78.3%和95.7%,100%,9O.9%,87.5%。所有46例肝门胆管癌病人行 MRC均能明确显示胆管梗阻部位和扩张的肝内胆道树。结论血清 CA19-9有助于肝门胆管癌的诊断。彩超,MRI 结合 MRC 是诊断肝门胆管癌的首选影像技术。
Objective To explore a practical and effective method for the diagnosis of hilar cholangiocarcinoma. Methods The clinical, laboratory and imaging results of 61 cases of hilar cholangiocarcinoma and 50 cases of benign biliary tract disease (intrahepatic bile duct stones with hepatic stenosis and hilar bile duct stenosis) were analyzed and compared. Results The main manifestations of hilar cholangiocarcinoma were obstructive jaundice and right upper abdominal pain. Serum CA19-9 levels in patients with hilar cholangiocarcinoma were significantly higher than those in benign controls (P<0.01). The sensitivity and specificity of serum CA19-9 and CEA in diagnosis of hilar cholangiocarcinoma were 83.6%, 17.4%, 68%, and 100%, respectively. The sensitivity and specificity of B-ultrasonography, computer-ultrasonography, CT, and MRI in the diagnosis of hilar cholangiocarcinoma were 70%, 97.9%, 71.9%, 78.3%, and 95.7%, 100%, 90%, and 87.5%, respectively. All of the 46 patients with hilar cholangiocarcinoma who underwent MRC clearly demonstrated biliary obstruction and dilated intrahepatic biliary tree. Conclusion Serum CA19-9 is helpful for the diagnosis of hilar cholangiocarcinoma. Color Doppler, MRI combined with MRC are the preferred imaging techniques for the diagnosis of hilar cholangiocarcinoma.