原发性肝癌合并胆管梗阻的影像诊断与介入治疗

Imaging diagnosis and interventional treatment for the primary hepatocellular carcinoma with biliary obstruction

目的 探讨原发性肝癌合并胆管梗阻的影像诊断与介入治疗价值。方法 对 2 6例原发性肝癌合并胆管梗阻者进行回顾性分析 ,所有患者均行超声和CT检查 ,18例行MRI检查 ,11例行PTC检查 ,10例行ERCP检查 ,12例行胆道内支架置入术 ,2 2例经肝动脉化疗栓塞 (TACE)治疗。结果 2 6例患者经超声、CT、MRI、PTC和ERCP等影像学检查后获得正确诊断。 12例患者分别置入了 4枚塑料内支架和 8枚金属支架 ,技术成功率为 10 0 % ,均有明显的减黄效果 ,患者术后 1周的血清胆红素水平由术前的 ( 2 96± 67) μmol/L降至 ( 10 4± 5 2 ) μmol/L(P <0 .0 5 )。 2 2例患者成功地进行了TACE治疗。结论 超声、CT、MRI和胆管造影检查对原发性肝癌合并胆管梗阻有较高的诊断价值 ,其相互补充有助于本病的正确诊断。胆道内支架置入术与TACE等介入治疗是其有效的治疗方法。

Objective To explore the value of imaging diagnosis and interventioanl treatment for primary hepatocellular carcinoma (PHC) with biliary obstruction.Methods Twenty-six patients with PHC with biliary obstruction (17 men, 9 woman; aged 32-65; average age, 44.5±7.4) were analyzed retrospectively. The sonography and CT were performed in all cases, MRI in 18, percutaneous transhepatic cholangiography (PTC) in 11, and endoscopic retrograde cholangiopancreatography (ERCP) in 10 cases. The biliary stent were placed in 12, and the transarterial chemoembolization (TACE) was performed in 22 cases.Results In 26 cases, correct diagnoses were obtained through sonography, CT,MRI, PTC and ERCP. The plastic stent were placed in 4 patients, metallic stent in 8, the technical successful rate was 100%. Serum total bilirubin dropped singificantly from (282±45)μmol/L to (104±52)μmol/L after the stent implantation at the first week (P<0.05). Successful TACE was performed in 22 cases.Conclusion Sonography, CT, MRI, PTC and ERCP have higher diagnostic value for PHC with biliary obstruction, and are complementary to one another. Interventional treatment including stent implantation and TACE is safe and effective for PHC with biliary obstruction.