| Objective: To analyze the clinical characteristics,diagnosis and treatment of intrahepatic cholangiocarcinoma(ICC),then to discuss related factors affecting the prognosis after radical resection of ICC.Furtherly to provide reference for clinical diagnosis and treatment of ICC.Method: This study included 95 cases of ICC including 42 cases of radical resection which were searched by the electronic medical record system in the First Affiliated Hospital of Hainan Medical university and Hainan Hospital Affiliated to Hainan Medical university from January 2015 to December 2018.To research those related contents including gender,age,liver function results,imaging examination,surgical methods and pathological results,then analyze the clinical features of ICC.Further more,to discuss the prognostic factors of patients with ICC after radical resection.Result:95 patients with complete data were enrolled in the study.The clinical data and survival analysis were as follows:1.The clinical data of 95 cases of ICC were as follows:(1)Clinical feature: Among 95 cases of ICC,the proportion of male and female patients was about 1.3:1,55.8%(53/95)of patients were male and 44.2%(42/95)patients were female.The median age was 62 years old(ranged from 41 to 86 years old),and 61.1%(58/95)were over 60 years old.37.9%(36/95)had biliary calculi,and15.8%(15/95)had hepatitis B,15.8%(15/95)had hypertension,5.3%(5/95)had diabetes,28.4%(27/95)had history of abdominal surgery.The main symptoms of patients were abdominal pain(61.1%),wasting(52.6%),and jaundice(41.1%).50.5%of patients combined with abdominal tenderness under palpation.(2)Laboratory examination: The rate were 42.1%(40/95)for abnormal ALT and52.6%(50/95)for abnormal AST;55.8%(53/95)for abnormal TBIL;62.1%(59/95)for abnormal ALB;42.1%(40/95)for abnormal PT.The positive rates of tumor markers CA19-9,CEA and AFP were 81.1%(77/95),51.6%(49/95)and 13.7%(13/95)respectively.The positive rate of at least one of these three was 91.6%(87/95).(3)In terms of imaging examination,the diagnostic coincidence rates of B ultrasound,CT and MRI were 71.6%(68/95),83.2%(79/95)and 75.8%(72/95)respectively.They had no statistical difference in the diagnostic coincidence rate(P>0.05).(4)Treatment method: the proportion for radical resection was 44.2%(42/95);for palliative surgery was 17.9%(17/95);for drainage operation was 34.7%(33/95);and for transcatheter hepatic arterial chemoembolization(TACE)was 3.2%(3/95).(5)Pathological characteristics after radical surgery: All of 42 cases were adenocarcinoma.Histological differentiation: high differentiation were 21.4%(9/42),medium differentiation were 50%(21/42),and low differentiation were 28.6%(12/42)respectively;tumor diameter>5cm accounted for 60%(25/42);vascular invasion accounted for 21%(9/42);the proportion of lymph node dissection were 38.1%(16/42).2.Prognostic factors of 42 cases of ICC undergoing radical resection.(1)Single factor analysis: the median survival time of 42 patients were 19 months.The results shows that gender,age,CA19-9,total bilirubin,AFP and hepatitis B are not related to the prognosis(P>0.05).Contrarily,histological differentiation degree,tumor size,vascular invasion and lymph node dissection are correlated with the prognosis(P<0.05).(2)Multiple-factor analysis: histological differentiation,tumor size,vascular invasion and lymph node dissection are independent prognostic factors of ICC patients after receiving radical resection(P<0.05).Conclusion:1.The main clinical symptoms of patients with ICC are abdominal pain,wasting and jaundice.Most patients of ICC have abnormal liver function,coagulation index and tumor marker.It may reduce misdiagnosis of ICC by Combined detection of multiple tumor markers.At present,the diagnostic rate of ICC using B-ultrasound,CT and MRI is high,but the radical resection rate is still low.The main pathological type of ICC is adenocarcinoma with high and medium differentiation,and vascular invasion is common.2.The prognosis of patients with ICC is poor.Histological differentiation,tumor size,vascular invasion and lymph node dissection are the independent prognostic factors of ICC patients after receiving radical resection.Radical hepatectomy combined with lymphadenectomy may improve the survival of patients with ICC. |
