肝细胞癌胆管转移致阻塞性黄疸的外科治疗

Surgery treatment for obstructive jaundice caused by hepatocellular carcinoma with tumor emboli of intraluminal bile duct

目的探讨原发性肝癌致阻塞性黄疸的原因及治疗方法。方法回顾性分析2003年9月至2014年8月收治的50例原发性肝癌致阻塞性黄疸的原因及治疗效果。结果 50例患者阻塞性黄疸均系肝癌引发胆总管癌栓所致。其中,45例进行了总胆管切开取癌栓T管引流术,同时行肝肿瘤切除22例、患侧肝动脉结扎者23例;5例进行了非手术治疗。在45例行手术治疗的患者中,17例肝左叶肿瘤患者术后平均生存11个月,28例肝右叶肿瘤患者生存7个月,总平均存活时间为9个月;5例非手术治疗患者平均生存时间仅3个月;手术患者较非手术患者平均存活时间明显延长(P<0.01)。结论外科手术明显延长阻塞性黄疸肝癌患者生存时间,改善其生活质量。

Objective To review the treatment for patients with obstructive jaundice caused by primary hepatocellular carcinoma（HCC）. Methods Fifty patients with obstructive jaundice caused by HCC undergoing surgical or non-surgical treatment from September 2003 to August 2014 were analyzed. Results All 50 patients with obstructive jaundice were caused by choledochal emboli. Among 50 patients, 45 cases received transcholedochal cancerous embolectomy plus T-tube drainage of the biliary tract, 22 cases with hepatoma removed, 23 cases with hepatic arterial ligation （HAL） ; 5 cases underwent non-surgical treatment. In 45 operated cases, 17 patients with left lobe HCC survived for 11 months after surgery, 28 patients with right lobe HCC survived for 7 months, with an overall survival of 9 months. Five non-operated patients survived for only 5 months. The overall survival time in operated patients was longer than that in non-operated patients （ P 〈 0. 01 ）. Conclusion Surgical treatment is effective in relieving symptoms and prolonging survival for HCC patients with obstructive jaundice.