肝细胞癌伴胆管癌栓的诊断与外科治疗

Diagnosis and surgical treatment of hepatocellular carcinoma with bile duct tumor thrombus

肝细胞癌(HCC)伴胆管癌栓(BDTT)的发生率较低,术前诊断较为困难。肝占位性病变和肝内胆管扩张是HCC伴BDTT的主要影像学特征。超声引导下行经皮肝胆管穿刺置管引流术是HCC伴BDTT术前首选的胆道引流方法。同时外科手术是其最有效的治疗手段。只要患者肝功能许可,尽可能行解剖性肝切除,尤其是肿瘤直径<5 cm时,既能切除肝内原发病灶,又能减少BDTT残留。“q”形胆总管切开取栓是一种安全有效的取栓方法,但目前对于是否切除肝外胆管还存争议。HCC伴BDTT肝移植术后复发率高,选择合适病例行肝移植尤为重要。

The incidence of hepatocellular carcinoma(HCC)with bile duct tumor thrombus(BDTT)is low,with difficulty in preoperative diagnosis.Liver mass and intrahepatic bile duct dilatation are the main imaging features of HCC with BDTT.Ultrasound-guided percutaneous transhepatic cholangial drainage is the preferred method of biliary drainage for HCC patients with BDTT before operation.Surgery is the most effective treatment.Anatomic resection of liver should be performed as long as the patient's liver function permits,especially if the tumor diameter is less than 5 cm,which can not only remove the primary tumor,but also reduce the residual BDTT.The“q”thrombectomy is a safe and effective method for thrombectomy.Whether or not to remove the extrahepatic bile duct remains controversial.The recurrence rate of HCC with BDTT after liver transplantation is high.And it is particularly important to select suitable patients for liver transplantation.