李锐锋　谭继初　蔡少雨

【摘要】 目的：研究高明地區肝吸虫性肝内胆管细胞癌的超声表现及临床特点。方法：回顾性分析本院52例经手术证实的肝内胆管细胞癌患者临床资料，总结合并肝吸虫病和未合并肝吸虫病的肝内胆管细胞癌患者超声表现特点，分析超声表现特点与病理组织分型的关系。结果：超声诊断检出率100%，与手术病理结果一致性高（Kappa=0.718，P=0.000），手术病理证实32例肝吸虫性肝内胆管细胞癌，肝右叶29例（90.63%）。超声诊断准确性为86.54%，敏感度为87.50%，特异度为85.00%。ROC分析显示超声造影诊断肝吸虫性肝内胆管细胞癌的AUC为0.856[β=0.059，95%CI（0.740，0.972）]。合并肝吸虫病与未合并肝吸虫病的肝内胆管细胞癌患者超声胆管扩张、双轨征及回声特点比较，差异均有统计学意义（P<0.05）。不同增强形态管状腺癌间癌细胞分布比较，差异有统计学意义（P<0.05），不同增强形态的乳头状腺癌细胞分布比较，差异无统计学意义（P>0.05）。结论：肝吸虫性肝内胆管细胞癌具有特异性超声征象，其超声征象与临床病理组织分型有关，早期行超声检查有助于筛查肝吸虫性肝内胆管细胞癌，判断组织病理分型，指导临床。

【关键词】 肝内胆管细胞癌； 肝吸虫感染； 超声； 病理

Ultrasonic Features and Clinical Analysis of Intrahepatic Biliary Cell Carcinoma of Liver with Hepatic Fluke in Gaoming Area/LI Ruifeng，TAN Jichu，CAI Shaoyu，et al.//Medical Innovation of China，2018，15（08）：070-073

【Abstract】 Objective：To study the ultrasonographic features and clinical analysis of intrahepatic biliary cell carcinoma of liver with hepatic fluke in Gaoming area.Method：The clinical data of 52 cases of intrahepatic cholangiocarcinoma confirmed by operation in our hospital were analyzed retrospectively.The ultrasonographic features of intrahepatic bile duct carcinoma complicated with hepatic fluke and without hepatic fluke disease were summarized，and the relationship between it and pathological classification was analyzed.Result：The diagnostic rate of ultrasonography was 100%，which was consistent with operation and pathological findings（Kappa=0.718，P=0.000），32 cases of intrahepatic cholangiocarcinoma were confirmed by operation and pathology，29 cases（90.63%） of right hepatic lobe.The accuracy of ultrasound diagnosis was 86.54%，the sensitivity was 87.50%，the specificity was 85.00%，ROC analysis showed that AUC was 0.856 in the diagnosis of intrahepatic cholangiocarcinoma of liver fluke by contrast-enhanced ultrasonography [（β=0.059，95%CI=0.740，0.972）].There were significant differences in intrahepatic bile duct dilatation，double track sign and echo feature in intrahepatic cholangiocarcinoma complicated with hepatic fluke and without hepatic fluke disease（P<0.05），there were significant differences in the distribution of tumor cells between tubular adenocarcinoma with different enhancement morphology（P<0.05），there were no significant differences in the distribution of papillary adenocarcinoma cells with different enhancement patterns（P>0.05）.Conclusion：The intrahepatic cholangiocarcinoma with hepatic fluke has specific ultrasonographic characteristics，the ultrasonographic features are related to the clinical pathological types，the early ultrasonography is helpful for screening intrahepatic bile duct carcinoma with hepatic fluke，judge the pathological classification and guide clinical practice.

【Key words】 Intrahepatic cholangiocarcinoma； Liver fluke infection； Ultrasonography； Pathological

First-authors address：Gaoming District Peoples Hospital of Foshan City，Foshan 528500，China

doi：10.3969/j.issn.1674-4985.2018.08.017

高明地区居民因喜食生鱼生虾，是肝吸虫性肝内胆管细胞癌的高发地区，而早期肝内胆管细胞癌起病隱匿，合并肝吸虫性感染者常伴有胆管炎，常与肿瘤症状重叠，增加漏诊和误诊率[1]。因而寻找有效的影像学检查方法对早期筛查肝吸虫性肝内胆管细胞癌具有重要意义。超声具有无创、简便、可重复、无辐射的优势，是临床常用的检查方法[2]。但目前临床尚未见有关肝吸虫感染所致的肝内胆管细胞癌超声报道。……