경희대학교
의과대학 외과 및 동수원병원 외과
김도균·이상목·고영관·주홍재·조광호*·홍성화
Intrahepatic
Cholangiocarcinoma in Hepatolithiasis
Do-Kyun
Kim, M.D,, Sung-Mok Lee, M.D., Youug-Gwan Ko, M.D.
Hong-Zae
Joo, M.D , Kwang-Ho Cho, M D.* and Sung-wha Hong, M,D.
Department
of Surgery, Kyunghee University Hospitil and
Department
of Surgery, Dongsuwoon Hospital, Korea
Background:
Hepatolithiasis is rarely associated with a cholangiocarcinoma and the etiologic
relationship between them has not been proved. Hepatolithiasis is a risk factor
for cholangiocarcinoma, Accurate preoperative diagnosis remains low, and the survival
outcome is still dismal, despite improvements in imaging studies:
Methods:
Eighteen cases of intrahepatic cholangiocarcinomas among the 522 cases undergoing
treatments from Jan. 1984 to May 1998 for hepatolithiasis at the Department of Surgery,
Kyung Hee University Hospital were reviewed.
Results:
The patients had a significantly long duration of symptoms. a high incidence of
previous biliary surgery, and a lower rate of preoperative diagnosis. The eighteen
cases accounted for 3.4% of the hepatolithiasis cases and 8.5% of the cholangiocarcinomas.
There were 17 women and l man, and the most prevalent age group was in the 5th and
the 6th decades. HBsAg was positive in one case who had chronic hepatitis, 3 patients
had clonorchiasis, and 2 patients had liver cirrhosis CEA and CA19-9 were elevated
in 42.9% (3/7) and 27.3% (3/11) of the patients. Various imaging studies, including
ultrasonography, CT, choangiography, angiography, and ERCP were performed for diagnosis
The malignant lesions could not be detected preoperatively in 9 patients, and the
presence of a coexisting malignant tumor was confirmed by frozen section or by permanent
tissue pathology. The operative methods were as follows; a lobectomy in 4 patients,
a segmentectomy in 4 patients, and a CBD resection for palliation or explo-laparotomy
only in 4 patients because of multiple hepatic metastases During the exact location
of the stones and the gross pathology of the tumor were recorded in each case. The
left side was more prevalent than the right. The mean survival was 15 months for
resection group and 9 month non resection group.
Conclusions:
The lower survival rates may be attributed to delayed diagnosis. lower diagnostic
accuracy, and relatively fewer Curative resections in the patients with stone-containing
cholangiocarcinomas. Hepatolithialsis is one of the risk factors of a cholangiocarcinoma.
During the diagnostic and operative procedures, we should not overlook a cholangiocarcinoma
which can coexist with hepatolithiasis. and we should examine tumor markers, the
results of imaging studies and tissue examinations, and the operative findings.
Key
Words: Hepatolithiasis, Cholangiocarcinoma |
