ERCP在肝细胞癌并胆管癌栓时的应用

Application of ERCP in hepatocellular carcinoma complicated with bile duct tumor thrombi

目的 探讨ERCP在肝细胞癌合并胆管癌栓处理中的作用。方法 回顾分析 1 5例肝细胞癌合并胆管癌栓患者的ERCP诊疗结果。其中ERCP检查后行内镜下胆管支架引流术 8例 ;内镜下鼻胆管引流术 7例 ;ENBD后再行内镜下胆管金属支架引流术 4例 ;内镜下乳头括约肌切开术后取栓及细胞刷 1 2例。ERCP加综合治疗 9例。结果 胆管造影共同表现为胆管腔内充盈缺损 ,可呈“球拍征”、“凝絮征” ;ERCP治疗后 1 3例有效。有效率为 86 7% ,ERCP后同时行综合治疗 ,均获良好的治疗效果。结论 ERCP在肝细胞癌并胆管内癌栓的诊治中有重要作用 ,“球拍征”、“凝絮征”

Objective To evaluate the value of ERCP in treating hepatocellular carcinoma complicated with tumor thrombi in bile duct.Methods To analyze retrospectively the results of 15 cases of hepatocellular carcinoma with tumor thrombi in the bile duct including ERBD 8 cases and ENBD 7cases,EMBE after ENBD 4 cases, EST with clearance of tumor thrombi and cytological brush 12 cases, ERCP conjugated with other compositive treatments 9 cases.Results The common feature of cholangiography is filling defect in the bile duct as the so called 'tennis bat' sign and 'flocculation' sign, 13 cases have got drainage successfully after ERCP with the effective rate 86 7%, Satisfactory results were obtained in patients received ERCP conjugated with other compositive treatments.Conclusion ERCP is very important treatment of hepatocellular carcinoma with tumor thrombi in the bile duct; the 'tennis bat' sign and 'flocculation' sign were the very important evidences of tumor thrombi in the bile duct. If combined with other compositive treatment such as surgery and TAE, ERCP is very effective treatment for the releasing symptoms, improving living quality and prolonging life span in these patients, even in some patients radical cure could be obtained.