探讨肝内胆管结石合并胆管癌（IHHCC）患者的临床诊治和预后。

回顾性分析2008年12月至2016年12月川北医学院附属医院收治32例行手术治疗的IHHCC患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男13例，女19例；年龄38～73岁，中位年龄61岁。分析患者临床病理学特征、诊治及预后情况。

入院前体重明显减轻11例；既往病史>10年者18例；有胆道手术史24例，手术史最短者6个月，最长者30年；术前中度贫血8例，重度贫血1例，CA19-9升高20例；超声检查示肝内胆管结石合并占位者13例；腹部CT、MRI、MRCP检查诊断为IHHCC 19例；术前检出率59%（19/32）。30例行肝切除手术，2例行肝肿瘤活检术，术后病理检查均提示为胆管细胞癌。2例行肝肿瘤活检术患者于术后2个月死于肿瘤转移、肝衰竭。仅1例患者术后生存时间超过5年，术后1、3、5年生存率分别为38%、16%、3%。

对于长期肝内胆管结石患者，出现消瘦、贫血、CA19-9升高应警惕合并胆管癌可能，术前诊出率较低，主要依靠影像学检查。手术切除仍是主要的治疗手段，但其预后较差。

To explore clinical diagnosis, treatment and prognosis of patients with intrahepatic hepatolithiasis associated with cholangiocarcinoma (IHHCC).

Clinical data of 32 patients with IHHCC receiving operative treatment in the Affiliated Hospital of North Sichuan Medical College between December 2008 and December 2016 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 13 males and 19 femaleswith the age of 38-73 years and the median age of 61 years. The clinical pathological characteristics, diagnosis, treatment and prognosis of the patients were analyzed.

Significant weight loss was observed in 11 cases before being hospitalized. Eighteen cases had a history of illness for over 10 years. Twenty-four cases had a history of biliary operation, with the shortest operative history of 6 months and the longest 30 years. Moderate anemia was observed in 8 cases, severe anemia in 1 case, elevated CA19-9 in 20 cases before operation. Intrahepatic hepatolithiasis associated with space occupying focus was observed in13 cases by ultrasonography. Nineteen cases were diagnosed as IHHCC by abdominal CT, MRI and MRCP. Thepre-operative detection rate was 59%(19/32). Thirty cases underwent hepatectomy, 2 underwent liver tumor biopsy, and the post-operative pathological examinations indicated all were cholangiocarcinoma. Two patients undergoing liver tumor biopsy died of tumor metastasis and hepatic failure 2 months after surgery. Only 1 patient lived for more than 5 years after surgery, and the 1-, 3-, 5-year survival rate was respectively 38%, 16% and 3%.

For long-term intrahepatic hepatolithiasis patients, bile duct tumor should be alert when suffering from emaciation, anemia and elevated CA19-9. The pre-operative detection rate is low, and diagnosis mainly depends on imageological examination. Surgical resection is still the main treatment option while the prognosis is relatively poor.