胆管内梗阻型原发性肝细胞癌36例临床分析

A clinical analysis of primary hepatocellular carcinoma complicated by intrabile duct obstruction: a report of 36 cases

目的 探讨胆管内梗阻型原发性肝细胞癌 (简称梗阻型肝癌 )的诊治方法。方法 回顾性分析 36例病人的临床资料并将其分成两组 :胆管探查“T”管引流组 (简称引流组 ) 18例 ;一期或分期肝切除组 (简称肝切除组 ) 18例。计算两组术后平均生存时间并进行统计学分析。结果 36例胆管内均发现栓子 ,病理学检查报告均为肝细胞癌栓。引流组、肝切除组的术后平均生存时间 (月 )分别为 (6± 5 )个月、(15± 13)个月 (P <0 0 5 )。结论 黄疸不一定是梗阻型肝癌的晚期表现 ,也不一定是手术禁忌证 ,一期或分期肝切除术常可获得较长术后生存时间。胆管内栓子的病理学检查是确诊的关键。

Objective To study the diagnosis and treatment of primary hepatocellular carcinoma (HCC) complicated by intrabile duct obstruction. Methods The clinical data of 36 HCC patients with intrabile duct abstruction caused by tumor thrombi were reviewed and divided into 2 groups: biliary tract exploration followed by T tube drainage in 18 patients (group A);hepatectomy performed at single or second stage in the other 18 (group B). Postoperative mean survival time (MST) of them were analysed. Results Tumor thrombi were found in all cases which were confirmed by histopathologic examination as the cause of the obstruction of the biliary tree. MST (month) for group A and B were 6±5 and 15±13,respectively (P<0 05)Conclusion Jaundice caused by intrabile duct tumor thrombi was not a contraindication for hepatectomy.Hepatectomy could result in a longer postoperative survival time. The key to the diagnosis was histopathologic examination of the thrombi.