胆管癌的临床表现、诊断及生存期:一项前瞻性研究

时间:2020-03-19 作者:翻译:于廷廷 审校: 点击:239次
Clinical presentation, diagnosis, and survival in cholangiocarcinoma: A prospective study.
胆管癌的临床表现、诊断及生存期:一项前瞻性研究
 
BACKGROUND AND STUDY AIMS: The diagnosis of cholangiocarcinoma (CCA) is difficult. The present study aimed to assess the clinical features, diagnosis, and survival in CCA.
背景与目的:胆管癌(CCA)的诊断很困难。本研究旨在评估CCA的临床特征,诊断和生存期。
PATIENTS AND METHODS: This is a prospective study on 46 patients with CCA who underwent endoscopic retrograde cholangiopancreatography (ERCP) or surgical resection and 20 controls with a clinical and ERCP suspicion for CCA in whom surgical biopsy and/or 4-year follow-up showed a benign biliary stricture.
方法:这是一项前瞻性研究,研究对象为46例接受内镜逆行胰胆管造影术(ERCP)或手术切除的CCA患者,以及20例临床和ERCP怀疑CCA而活检和/或4年随访表现为良性胆道狭窄的对照患者。
RESULTS: The median age at presentation was 71years (range 44-88). Thirty-four patients (73.9%) presented with painless jaundice. Median CA 19-9 value was 188IU/L (range 1-49,138), with a level of 100IU/L in 13 patients (28%). Total bilirubin was 11.9 (0.6-36.3)mg/dL. The tumour was intrahepatic in 3 (6.5%), hilar (Klatskin) in 25 (54.3%), and located in the lower third of the bile duct in 18 (39.1%) patients. The diagnosis was confirmed by positive cytology in 10 (21.7%), biopsy in 20 (43.5%), cholangioscopy in five (10.9%), and imaging and clinical grounds in 11 (23.9%) patients. Cytology was feasible in 36 patients; it was positive in 10 and "highly indicative" in two patients (33.3% sensitivity). Twenty-two patients (47.8%) were treated by surgical resection, and the rest were offered palliative biliary drainage. Mean estimated survival for the entire group of CCA patients was 21.5±3.3months. Survival was slightly longer in patients who underwent surgical resection than those who had palliative treatment; the estimated mean survival rates were 26.2±4.2 vs. 17.1±3.3months, respectively, but the difference was not statistically significant (p=0.115).
结果:发病中位年龄为71岁(范围44岁-88岁)。 34例患者(73.9%)表现为无痛性黄疸。 CA 19-9的中值为188IU / L(范围1-49,138),其中13例患者(28%)CA 19-9的水平为100IU / L。总胆红素的中值为11.9(0.6-36.3)mg / dL。患者肿瘤位于肝内3例(6.5%),肝门部(Klatskin)25例(54.3%),胆管下三分之一部位18例(39.1%)。确诊诊断方法中,细胞学阳性10例(21.7%),活检20例(43.5%),胆管镜检查5例(10.9%),影像学和临床依据11例(23.9%)。在36例患者中进行细胞学检查。其中10例为阳性,2例为“高度倾向”(敏感性33.3%)。22例(47.8%)接受外科手术切除,其余患者行姑息性胆道引流。整个CCA患者组的平均估计生存时间为21.5±3.3个月。接受手术切除的患者的生存期比接受姑息治疗的患者略长。平均估计生存率分别为26.2±4.2个月和17.1±3.3个月,但差异无统计学意义(p = 0.115)
CONCLUSION: The diagnosis of CCA is difficult and often delayed. The outcome is generally poor.
结论:胆管癌(CCA)的诊断困难,并且经常延误。预后通常很差。

翻译:于廷廷 审校:张立超 侯森林

Clinical presentation, diagnosis, and survival in cholangiocarcinoma: A prospective study.