原发性肝癌合并胆管癌栓的外科治疗

Surgical therapy of primary liver cancer associated with carcinoma thrombosis of biliary

目的:提高对原发性肝癌合并胆管癌栓的认识,探讨其诊断、治疗方法及疗效。方法:回顾性分析我院1998年1月至2004年1月间收治的42例原发性肝癌合并胆管癌栓的临床资料,施行根治性手术26例,其中18例肝叶切除+胆总管切开取栓、T管引流术;8例肿瘤局部切除+胆总管切开取栓、T管引流术;姑息性手术16例,其中6例胆总管切开取栓、T管引流术,10例胆总管切开取栓、T管引流术+患侧肝动脉结扎术(其中4例+门静脉DDS泵置入术)。均获得病理诊断,肝细胞癌32例(76.2%)。结果:根治性手术及姑息性手术1年、3年、5年生存率分别为65.4%(17/26),42.3%(11/26),15.4%(4/26)及18.8%(3/16)、6.3%(1/16),0(0/16);总的1年、3年、5年生存率分别为47.6%(20/42),28.6%(12/42),9.5%(4/42)。结论:外科治疗明显改善患者生活质量,提高了生存时间,而根治性手术是原发性肝癌合并胆管癌栓的积极有效方法。

Objective：To enhance the awareness of primary liver cancer associated with carcinoma thrombosis of biliary, the diagnosis ,treatment and curative effect were discussed. Methods： To summarize the outcomes of different manner of operation retrospectively of clinical data of 42 patients of primary liver cancer associated with carcinoma thrombosis of biliary from January 1998 to January 2004, 26 cases were parfomed radical resection, in which 18 of them were operated with resection of liver lobe and out of thrombosis from common bile duct and T - tube drainage, and 5 of them were operated with local resection of tumor and out of thrombosis from common bile duct and T - tube drainage, in 16 patients palliative resection were undertaken, 6 of them were operated with out of thrombosis from common bile duct and T- tube drainage, and 10 of them were operated with out of thrombosis from common bile duct and T - tube drainage and ligature of hepatoartery on side of tuomr （ DDS pump was inserted into portal vein for 4 patients）. All of the patients was diagnosed by pathology examination ,32 patients with hepatocellular cancer. Results： Among 26 cases with radical resection, 1 year survival rate was 65.4% , 3 year survival rate was 42.3% and 5 year survival rate was 15.4% ; Among 16 patients with palliative resection, 1 year survival rate was 18.8% , 3 year survival rate 6.3% and 5 year survival rate was 0. For all of 42 patients, 1 year survival rate was 47.6% , 3 year survival rate 28.6% and 5 year survival rate 9.5 %. Conclusion： By surgical therapy, the life quality was improved and the survival time was raised. The radical resection is an active and efficient management for primary liver cancer associated with carcinoma thrombosis of biliary.