布-加综合征合并肝细胞肝癌诊治分析:附33例报告

Diagnosis and treatment of Budd-Chiari syndrome complicated with hepatocellular carcinoma: a report of 33 cases

目的探讨布-加综合征(Budd-Chiari syndrome,B-CS)合并肝细胞肝癌(Hepatocellular carcinoma,HCC)的诊断及治疗方法。方法回顾性分析本院2011年1月至2014年11月收治的33例B-CS合并HCC患者的临床资料。结果 B-CS合并HCC多见于下腔静脉型(8/33)及混合型(24/33)患者。33例患者中5例合并HBV感染,1例合并HCV感染,19例患者血清甲胎蛋白(alpha fetoprotein,AFP)大于400ng/ml。HCC影像学表现为位于肝脏周边及实质内的单发或多发肿物,6例存在门静脉侵犯,1例存在胆管侵犯。治疗上先解除下腔静脉梗阻(3例失败),然后22例行肝动脉化疗栓塞术(Transcatheter arterial chemoembolization,TACE),7例行手术切除,1例先后行TACE及手术切除,3例保守治疗。随访24例,平均随访22.4个月,其中7例死亡,17例生存良好。结论 B-CS并发HCC无特异临床表现,AFP及影像学检查可为诊断提供依据,血管成形联合手术或TACE可获得较好的治疗效果。

Objective To explore the diagnosis and treatment of Budd-Chiari syndrome(B-CS) complicated with hepatocellular carcinoma(HCC). Methods The clinical data of 33 patients of B-CS complicated with HCC hospitalized from January 2010 to November 2014 was analysed retrospectively. Results Main forms of the B-CS complicated with HCC were the inferior vena cava obstruction type(8/33) and mixed type(24/33). Among the 33 patients, 5 cases were complicated with HBV infection and 1 case with HCV infection, and the serum alpha fetoprotein(AFP) level was higher than 400ng/ml in 19 cases. Single mass or multiple masses located in the periphery or parenchyma of the liver were discovered on imaging examination, and portal vein invasion was seen in 6 cases and biliary tract invasion was seen in 1 case. The obstructive status of the inferior vena cava of all 33 cases was relieved firstly(3 cases failed), then 22 cases were treated with transcatheter arterial chemoembolization(TACE), 7 cases with surgical excision, 1 case with TACE and surgical excision sequentially, 3 case with conservative treatment. Among the 24 patients followed up for 22.4 months on average, 7 cases died and 17 cases survived. Conclusions B-CS complicated with HCC has no specific clinical manifestation. AFP level and imaging examination could provide reference points for the diagnosis. Angioplasty combined with surgical excision or TACE could make better outcomes.