肝细胞癌侵入胆管致阻塞性黄疸(附16例报告)

Obstructive jaundice caused by hepatocellular carcinoma (a report of 16 cases)

目的 探讨肝细胞癌侵入胆管致阻塞性黄疸的诊断与治疗。方法 对 1989年 1月～ 1998年 12月收治的 16例病人的诊断与治疗情况行回顾性分析。结果 术前确诊 2例 ,误诊 14例。行肝叶切除、胆管内肿瘤摘除、T管引流 2例 ,胆管内肿瘤摘除、胆管支架及T管引流 11例 ,肿物活检及T管引流 2例 ,1例未及手术死亡。 15例病人随访 1～ 14个月 ,14例于术后 6个月内死亡 ,1例随访 14个月仍存活。结论 对黄疸伴有HBsAg阳性、AFP阳性、肝内有占位、肝内外胆管扩张且其内有占位病变的病人 ,可诊断为本病。B超 ,CT ,PTC ,ERCP为诊断的主要手段。切除肝内原发肿瘤、疏通胆道为手术治疗的最佳选择。

Objective To investigate the diagnosis and treatment of obstructive jaundice (OJ) caused by hepatocellular cacinoma (HCC) invasion to bile duct. Methods The diagnosis and treatment of 16 cases of OJ caused by HCC in our hospital from January 1989 to December 1998 were retrospectively analysed. Results Correct diagnosis was made in 2 cases and misdiagnosis in 14 cases preoperatively. 14 cases were operated on, including hepatectomy, enucleation of the tumor in the common bile duct (CBD) and T tube drainage in 2 cases; enucleation of the tumor in CBD and internal stent of T tube drainage in 11 cases; tumor biopsy and T tube drainage in 2 cases; one case died without operation. 15 cases were followed-up for 1 to 14 months postoperatively. The results demonstrated that 14 patients died within 6 months, and only 1 case remained alive for 14 months after operation. Conclusions The correct diagnosis of this disease could be made for the patients with jaundice accompanied with positive of HbsAg and AFP, local lesions in the liver and the dilated bile duct. B-US, CT, PTC and ERCP are the main examination methods for the diagnosis. The best treatment of this kind of HCC is to remove the hepatic tumor and to recanalize the affected bile ducts.