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目的分析肝癌合并胆道癌栓的临床症状、实验室检查、影像学及病理特点,探讨术前诊断规律。方法对1990年5月至2006年5月我院收治的148例肝癌合并胆道癌栓病人的临床资料进行回顾性分析和总结。结果主要临床症状为肝内占位、胆道扩张及胆道占位的表现。实验室检查甲种胎儿球蛋白阳性126例,乙型肝炎病毒表面抗原阳性130例。术前总胆红素、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、碱性磷酸酶、γ-谷氨酰转移酶及白细胞等均有不同程度的升高。影像学特征为肝内占位、胆道扩张和胆道内占位的直接和间接影像学表现。术中见癌栓组织与胆道壁不相连,与肝内原位病灶相连或不相连。结论结合病史,选择各种检查手段,综合分析,提高对此类疾病的认识,可望提高术前诊断率。
Objective To analyze the clinical symptoms, laboratory tests, imaging and pathological features of hepatocellular carcinoma with cholangiocarcinoma and to explore the preoperative diagnosis. Methods The clinical data of 148 patients with hepatocellular carcinoma complicated with cholangiocarcinoma admitted to our hospital from May 1990 to May 2006 were retrospectively analyzed and summarized. Results The main clinical symptoms were intrahepatic space occupying, biliary dilatation and biliary appendage. A laboratory test fetus globulin positive 126 cases, hepatitis B virus surface antigen positive 130 cases. Preoperative total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transferase, and leukocytes were all increased to varying degrees. Imaging features are direct and indirect imaging of intrahepatic space occupying, biliary dilatation and biliary tract occupancy. Intraoperative see thrombus tissue and biliary wall is not connected with the liver in situ lesions connected or not connected. Conclusion Combined with medical history, choose a variety of examination methods, comprehensive analysis, to improve awareness of such diseases, is expected to increase the preoperative diagnosis rate.