肝细胞癌合并胆管癌栓的诊断与治疗(附16例报告)

Diagnosis and treatment of bile duct tumor thrombus in patients with hepatocellular carcinoma

目的 探讨肝细胞癌 (HCC)合并胆管癌栓的诊断、治疗及影响预后的因素。方法 对1987年 7月～ 1998年 10月收治的 16例HCC合并胆管癌栓的诊疗情况进行回顾性总结和分析。结果16例中 ,除 1例行肝左外叶切除 +肝动脉结扎插管 +胆总管癌栓取出术外 ,余 15例均行肝切除术及胆管癌栓取出术。随访满 1年以上的 14例中 ,10例生存 1年以上 ,1年生存率为 71.4% ,其中 3例女性生存分别为 4年、6年和 12年 ;8例术后 1年内出现肿瘤复发 ,1年复发率 5 7.1%。结论 提高对肝细胞癌合并胆管癌栓的认识、力争及早确诊并予以积极的手术治疗 ,是改善此病预后的关键。

Objective Tumor thrombus in the bile duct (BDT) is very rare in patients with hepatocellular carcinoma (HCC). The prognosis of the patients with BDT is very poor. To improve the prognosis, HCC patients with BDT were retrospectively reviewed. Methods Retrospective study was performed in 16 cases of HCC with BDT found in authors′ institute from July 1987 to Oct. 1998. Factors affecting prognosis were analyzed. Results The occurrence rate of BDT was 0.76% (16/2100). Removal of BDT and HCC was performed in all but one patients. Fourteen patients were followed up for over 1 year after operation. The 1 year survival and recurrence rate was 71.4% (10/14) and 57.1% (8/14), respectively. Three female patients survived over 4, 6, and 12 years, respectively.Conclusions Early detection and diagnosis, surgical removal of primary tumors and BDT are the key points to prolong the survival time of patients.