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頁籤選單縮合
| 題 名 | 肝內結石合併膽管癌 |
|---|---|
| 作 者 | 詹益銀; | 書刊名 | 中華民國外科醫學會雜誌 |
| 卷 期 | 21:2 1988.03[民77.03] |
| 頁 次 | 頁181-187 |
| 分類號 | 416.247 |
| 關鍵詞 | 肝內結石; 膽管癌; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 長庚紀念醫院一般外科自1977年至1984年間共經歷13例肝內結石合併胆管癌。症狀以及覆性胆管炎一上腹部疼痛(100%)、上腹部壓痛(92%)、發燒畏冷(77%)及黃疸(46%)最常見,其次為體重減輕(69%)。胆管癌的位置;肝藏左葉7例、右葉3例、兩葉性2例及肝門 部1例。肝內結石的位置;兩側肝管7例、左側5例及右側1例。胆管癌側之肝管內92%有胆石存在。 肝內結石症術前以腹部超音波、胆道核子閃爍攝影(IVRC)、內視鏡逆行性胆管攝影(ERC)或經皮穿肝胆道攝影(PTC)檢查,92.3% (12/13)得到正確的診斷;而且胆管癌之術前診斷率相當低,7位病人接受超音波檢查有2例懷疑有腫瘤存在。5例肝臟核子閃爍攝影3例發現有占位性之病變。胆道攝影檢查13例中8例顯示胆管癌側之肝管阻塞或不顯影。 肝內結石症合併胆管癌之發生率為2.36%(13/550);而胆管癌病人有用胆道結石之發生率為32.7%。13例胆管癌為人手術中有10例僅接受肝臟切片檢查,3例接受左葉肝切除術,手術死亡率(1個月內死亡)為7.7%(1/13)。治存期間4個月至3年6個月,超過1年以上者3例占23%,平均為9.7個月。 |
| 英文摘要 | Five hundred and fifty cases of intrahepatic stones underwent surgery at Chang Gung Memorial Hospital between 1977 and 1984. Among them, 13 cases were found in association with cholangio-carcinoma. They manifested by repeated cholangitis (100%), body weight loss (69%), and anemia (69%). In none of them, was the diagnosis of cholangioma established before operation. The major diagnostic procedures employed for these cases were reviewed retrospectively. In addition to the defmitive diagnosis of intrahepatic stones having beenmade in 12 ou t of 13, hyperechoic mass by abdominal echo was found in 2 out of 7, space occupying lesions by liver scanning in 3 out of 5 and non-visualization or obliteration of unilateral intrahepatic duct by cholangiogram (ERC, PTC, T-tube) in 8 out of 13. In the 13 cases who underwent surgery for intrahepatic stones, stones were removed from the right IHD in one, left in 5 and bilaterally in the remaining 7. Location of tumors were in the left lobe in 7, right in 3, both lobes in 2 and another single tumor was found in the hepatic hilum. The location of stones and tumor was confined to the same lobe of liver in 92% of the patients. A defmitive diagnosis of cholangiocarcinoma was made during laparotomy by the gross fmding of the liver and followed by histological examination. Surgical procedures included biopsy in 10 and left hepatectomy in 3. Operative mortality rate within one month was 7.7% (1/13). Survival times ranged from 1-44 months with a mean survival period of 9.7 months. |
本系統中英文摘要資訊取自各篇刊載內容。