原发性肝癌伴胆道癌栓的诊治

DIAGNOSIS AND TREATMENT OF PRIMARY HEPATIC CANCER AND CONCURRENT CANCER EMBOLUS IN BILIARY TRACT

目的 总结探讨 16例原发性肝癌伴胆道癌栓的临床特点、病理改变、诊治方法和改善预后的途径。方法 综合分析 16例病例的一般资料、临床表现、影像学和病理检查。均接受外科手术治疗 ,其中原发肿瘤切除 +胆道癌栓清除 +T管引流 -化疗 14例 ,单纯癌栓清除 +T管引流 2例 ,术后 TACE 14例 ,化疗药物 T管滴注或灌注 9例 ,术后二者同时化疗者 9例。结果 无手术死亡。原发灶未切除仅 T管引流 2例 ,术后生存时间为 2 .5个月和 4 .5个月。 14例原发灶切除者 ,术后生存 1年、1.5～ 2年、2～ 2 .5年、2 .5～ 3年分别为 12例、9例、6例和 3例 ,其中 1例存活 4 .5年。结论 原发性肝癌伴胆道癌栓患者 。

Objective To summarize and explore the clinical and pathological characteristics,diagnosis and treatment methods,and improve prognostic ways of primary hepatic cancer (PHC) with cancer embolus in biliary tract(CEBT).Methods The sixteen patients with CEBT of PHC were analysed complexly and their general data,clinical manifestation,image and pathological examination,accomplished surgical treatment in all patients.14 cases under went primary tumor resection and CEBT elimination and T tube drainage chemotherapy,simple elimination of cancer embolus and T tube drainage in 2 cases,postoperative TACE in 14 cases,chemoth rapeutic drug T tube drip or perfusion in 9 cases,postoperative TACE and chemotherapeutic drug T tube drip or perfusion underwent simultaneously in 9 cases.Result No patients died after operation.Two patients with primary tumor nonexcision lived out separately 2.5 months and 4.5 months.For 14 survivors with primary tumor excision,the 1 year survivors was 12 cases,from 1.5 to 2 years was 9 cases,from 2 to2.5 years was 6 cases,from 2.5～3 years was 3 cases,one of 14 cases lived out 4.5 years.Conclusions For patients with PHC combined CEBT,postitive operative treatment and complex treatment is an effective therapy to increase quality of life and improve prognosis.