原发性肝癌伴胆管癌栓导致阻塞性黄疸的诊治

Diagnosis and treatment of obstructive jaundice caused by HCC with bile duct cancer

目的 :探讨原发性肝癌继发胆管癌栓引起阻塞性黄疸 (阻黄 )的临床表现、诊断、治疗及手术方式与预后的关系。方法 :回顾分析我院收治的 11例阻黄患者的临床资料。结果 :患者的临床症状不典型 ,入院后按常规均行化验及B超、CT、ERCP、MRCP、PTC等检查 ,并分别行肝原发癌灶切除、胆管癌栓清除、T管引流、肝动脉插管埋泵等手术治疗 ,术前诊断符合率为 4 5 .5 %。术后对症化疗。患者预后与术式有关 ,行切除肝内原发肿瘤 +胆道癌栓清除术者预后较好 ,行单纯癌栓清除术者预后较差。结论 :原发性肝癌继发胆管癌栓引起阻黄术前不易诊断 ,应选择多种检查手段 ,包括术中B超、纤维胆道镜等检查 ,力求确诊 。

Objective:To explore the clinical features,diagnosis,treatments of obstructive jaundice due to bile duct cancer embolus caused by HCC and the relationship between types of operative procedures and the prognosis.Methods:The clinical data of 11 cases of such disease in our hospital were retrospectively reviewed.Results:As the clinical symptoms were untypical,all the patients were examined with routine laboratory tests and B us,CT,ERCP,MRCP,and PTC etc. Operations including resection of HCC focus,clearance of bile duct embolus,T tube drainage,hepatic arterial catheter intubation and port implantation were performed respectively,accompanied with postoperative chemotherapy,and the rate of correct preoperative diagnosis was 45.5%. The prognosis was related to the type of operation procedures. Resection of primary liver carcinoma focus plus clearance of bile duct embolus had better prognosis than clearance of bile duct embolus only.Conclusion:Because of the difficult preoperative diagnosis the obstructive jaundice due to bile duct cancer embolus caused by HCC,multi examinations including the use of intra operative ultrasonography and fiber choledochoscope are necessary. Resection of primary liver cancer focus is strongly advised to improve the result.