原发性肝癌合并胆管内癌栓12例临床分析

THE CLINICAL ANALYSIS OF 12 CASES WITH PRIMARY HEPATIC CARCINOMA COMPLICATED WITH BILIARY DUCT CARCINOMA THROMBI

目的探讨原发性肝癌继发胆管癌栓的临床特点和诊治要点。方法回顾性分析1990～2003年12例HCC伴癌栓的外科治疗情况。结果本组原发性肝癌合并胆管内癌栓的发生率为4.69%(12/256),术前确诊率为25%(3/12),肝癌切除加胆管癌栓清除术8例,肝癌切除加肝外胆管切除,胆肠内引流1例,单纯胆总管切开取栓术3例。术后1年生存率66.7%(8/12),3年生存率25%(3/12),其中1例生存已超过5年。结论原发性肝癌伴胆管内癌栓十分少见,术前易误诊,手术治疗不失为一种积极有效的治疗方法。

Objective To investigate the clinical characteristics and surgical management for primary hepatic carcinoma thrombi.Method The data of twelve primary hepatic carcinoma patients with biliary duct carcinoma thrombi from 1990 to 2003 were studied retrospectively.Results Among 256 patients with primary hepatic carcinoma patients,before biliary duct carcinoma thrombi occurred in twelve patients with the incidence of 4.69 percent.The diagnosis was established in 3 cases(25 percent) before operation.Eight cases were the removal of hepatoma and cholangiocarcinoma.The carcinoma thrombi was dislodged by choledochotomy in 3 cases.One case was chole-intestinal internal drainage after the removal of hepatoma and extrahepatic bile duct.The one-year survival rate after operation was 66.7 percent(8/12).The three-year survival rate after operation was 25.0 percent(3/12).One patient had survived more than 5years.Conclusion The primary hepatic carcinoma patients with biliary duct carcino-embolism were rarely.It was easy to misdiagnosis.The surgical intervention was the positive treatment for those patients.