原发性肝癌合并胆道癌栓的诊断

Diagnosis of primary liver cancer complicated with bile duct embolus

目的 分析原发性肝癌并胆道癌栓的临床、影像学及病理特点 ,总结其诊断的规律。方法 分析近 4年来我院收治的肝癌并胆道癌栓 42例病人的一般情况 ,病人入院后行常规实验室检查及B超、CT、MRI、ERCP、PTC等检查。结果 本组术前正确诊断率为 71.8%。临床表现为肝癌及梗阻性黄疸症状。实验室检查AFP阳性 2 7例 ,乙肝表面抗原阳性 2 8例。术前血清胆红素增高者 33例 ,血清碱性磷酸酶增高 19例 ,白细胞增高 18例。影像学特点为 :肝内肿瘤 ,胆道扩张 ,胆道内占位。术中见癌栓组织松脆易碎 ,多与胆道壁无相连 ,与肝内原发病灶相连或不相连。B超、CT、MRI、ERCP、PTC的正确诊断率分别为 8.11%、2 .6 3%、10 .0 0 %、6 9.70 %、10 0 %。结论 肝脏占位 ,肝炎病史 ,AFP升高同时出现胆道扩张、黄疸 ,应考虑到本病存在 ,并选择多种检查手段 ,综合分析结果。

Objective To analyze the clinical, imaging and pathological features of the primary liver cancer complicated with bile duct embolus and sump up the laws in its diagnosis. Methods A retrospective study was conducted to review 42 patients with primary liver cancer complicated with bile duct embolus that were treated in our hospital in the past 4 years. All the patients were examined with ultrasonography B (B us), computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC). Results The rate of correct diagnosis was 71.8%. The major manifestation was symptoms of primary liver cancer and obstructed jaundice. The laboratory test showed that 27 patients were alpha fetoprotein (AFP) positive and 28 hepatitis B surface antigen positive. Before the operation, there were elevated total serum bilirubin in 33, alkaline phosphatase in 19 and white blood cell count in 18. The imaging features were intrahepatic tumor, bile duct dilation, space occupying lesion in the bile duct. The bile duct emboli were loose, soft, fragile and being connected to the major tumor lesion or not. Most of the emboli did not adhere to the bile duct wall. The rates of correct diagnosis were 8.11% by B us, 2.63% by CT, 10.00% by MRI, 69 70% by ERCP and 100% by PTC. Conclusion If a patient has the intrahepatic tumor, history of hepatitis, AFP elevation in combination with bile duct dilation and the symptom of jaundice, we should consider that the patient is suffering from the primary liver cancer complicated with bile duct embolus.