肝细胞癌合并胆管癌栓二例并文献复习

Two cases of hepatocellular carcinoma plus bile duct tumor thrombus and a literature review

华中科技大学同济医学院附属武汉中心医院2021年收治肝细胞癌合并胆管癌栓2例,其中1例由于肝内未见明显病灶且甲胎蛋白(AFP)阴性,术前极易误诊为胆管癌,另1例为高龄病人肝癌术后复发合并胆管癌栓,经保守治疗之后病情好转。结合该2例病例,作者对肝细胞癌合并胆管癌栓的临床诊治进展进行文献复习,分析该病的发病机制、诊断及治疗方式等。结论:肝细胞癌侵犯肝内外胆管形成胆管癌栓在临床上较少见,易被误诊为胆管癌、胆道结石、胆管炎等,目前其术前诊断主要依赖于影像学检查,治疗上采用手术治疗为主的综合治疗。

Two rare cases of hepatocellular carcinoma(HCC)plus bile duct tumor thrombus(BDTT)were admitted in 2021.In one case,small primary intrahepatic tumor with a negative alpha-fetoprotein was easily misdiagnosed as cholangiocarcinoma preoperatively.Another senile case had recurrent HCC plus BDTT.The latter improved after conservative measures.The authors reviewed the literature on clinical management of HCC plus BDTT and analyzed its pathogenesis,diagnosis and treatment.HCC invading intra/extra-hepatic bile ducts to form BDTT is rare in clinical practices and it may be easily misdiagnosed as cholangiocarcinoma,choledocholithiasis and cholangitis.Currently its preoperative diagnosis is dependent upon imaging examination and comprehensive therapy is dominated by surgery.