胆管癌栓的内镜介入治疗

Endoscopic interventional therapy of cancer embolus in bile duct

目的探讨肝细胞癌合并胆管癌栓的诊断、内镜介入治疗及影响预后的因素.方法对1999年1月～2003年6月收治的23例肝细胞癌合并胆管癌栓的诊断情况进行回顾性总结分析.结果23例均采用内镜介入胆道引流术引黄,23例均行乳头括约肌切开,同时行鼻胆管引流治疗10例,胆管内支撑引流治疗9例,乳头括约肌切开取栓4例.通过内镜引流使患者的肝功能得到改善,总胆红素由治疗前的平均352.67μmol/L降至38.42μmol/L,黄疸消除率86.7%.结论肝细胞癌伴胆管癌栓的内镜介入治疗方法可行,能有效解除胆道梗阻,缓解症状,为后继治疗创造条件.

Objective: To investigate the diagnosis, endoscopic interventional therapy and the factors that affact prognsis os primary hepatocellular carcinoma (HCC) with cancer embolus in bile duct. Methods: The data of 23 patients with cancer embolus in bile duct for diagnosis from January 1999 to June 2003 in our hosital were retrospectively analysed. Results: All the 23 cases received drainage operation which endoscopes intervents bile duct to driam bile. Of them, all the cases underwent endoscopic sphincterotomy (EST), 10 cases were treated with endoscopic nasobiliary drainage (ENBD), 9 cases were treated with endoscopic retrograde biliary drainage (ERBD), 4 cases received EST to remove embolus.The patient′s hepatic function was improved by drainage. The average serum total bilirubin (STB) decreased from 352.67 ìmol/L(pre-therage) to 38.42 ìmol/L (post-therapy). The eliminating tate of jaundice was 86.7%. Conclusion: Endoscopic interventional therapy for HCC with cancer embolus in bile duct is feasible. It can relieve the biliary obstruction efficiently,relax the clinical symptoms and provide for the subsequent treatment.