原发性肝癌合并胆管癌栓的临床诊治

Clinical diagnosis and treatment of hepatocellular carcinoma combined with bile duct tumor thrombi

目的探讨原发性肝癌合并胆管癌栓临床诊治策略的选择。方法回顾性分析2016年8月~2019年8月解放军总院海南医院肝胆外科20例原发性肝癌合并胆管癌栓患者的外科诊治情况。结果20例均行外科手术,4例行左(右)半肝切除+胆管取栓,7例行肝脏肿瘤切除+胆管取栓,4例行肝脏肿瘤射频消融+胆管取栓,3例单纯行胆管切开取栓+T管引流术,2例行经皮经肝胆管引流术。术后随访至今,其中左(右)半肝切除及胆管取栓患者平均生存时间36.2月,肝脏肿瘤切除及胆管取栓平均生存时间34.6月,肝脏肿瘤射频消融及胆管取栓平均生存时间28.2月,单纯行胆管取栓平均生存时间13.6月,经皮经肝胆管引流减黄平均生存时间5.8月。结论原发性肝癌合并胆管癌栓,早期诊断,积极切除肿瘤及清除胆管癌栓可获得较好的临床疗效。

Objective To evaluate the choice of clinical diagnosis and treatment strategies for hepatocellular carcinoma(HCC)complicated with bile duct tumor thrombi.Methods A retrospective analysis of the surgical diagnosis and treatment of 20 cases of hepatocellular carcinoma with bile duct tumor thrombi in the hepatobiliary surgery of Hainan Hospital of PLA General Hospital from August 2016 to August 2019.Results Surgical operations were performed in all 20 cases.Four cases of left(right)half-hepatectomy+removal of thrombus in bile duct.Seven cases of resection of liver tumor and removal of thrombus in bile duct.Four cases radiofrequency ablation of liver tumors+removal of thrombus in bile duct.Three cases simple bile duct incision and thrombus T tube drainage,percutaneous transhepatic bile duct drainage in 2 cases.Postoperative followup to date,the average survival time of patients with left(right)half-hepatectomy and bile duct thrombus removal was 36.2 months.The average survival time of tumor resectionand and bile duct thrombus removal was 34.6 months.The average survival time of radiofrequency ablation and bile duct thrombus removal was 28.2 months.The average survival time of the simple-line bile duct was 13.6 months.The average survival time of percutaneous transhepatic bile duct drainage and yellowing reduction was 5.8 months.Conclusion Hepatocellular carcinoma complicated with bile duct tumor thrombus,early diagnosis,active resection of tumor and removal of bile duct tumor thrombi can obtain better clinical effect.