原发性肝癌并胆管癌栓的临床诊治分析：附19例报告

摘要

Objective:To investigate the diagnosis of hepatocellular carcinoma( HCC)with tumor thrombus in bile duct( BDT)and explore the best treatment. Methods:Retrospective study was performed in 19 patients under-went surgical treatment for HCC with biliry tumor thrombi. The diagnosis,diagnostic errors and treatment effectiveness were analyzed. Treatments included resection of HCC with BDT,cholangiotomy with BDT resection,and biliary tract prosthesis drainage. Results:Hepatectomy with removal of biliary tumor thrombi was performed in 7 patients,the aver-age survival time was over 3 years,one patient survived over 5 years. The average survival time of 6 cases who re-ceived cholangiotomy with BDT resection was 18 months. 6 cases were treated by biliary tract prosthesis drainage,with an average survival time of 5. 6 months. Conclusion:Surgical operation is the most important prognostic factor for HCC patient with BDT. Early diagnosis and surgery after appropriate preoperative management of hepatocellular carci-noma with biliary tumor thrombi is effective in improving the life quality and prolonging life span.%目的：探讨原发性肝癌合并胆管癌栓的诊断方法和治疗方式的选择。方法：回顾性分析我院2003年1月至2011年12月收治的19例原发性肝癌合并胆管癌栓的诊断方法、误诊原因及综合治疗效果。应用B超、CT、MRCP和PTC等检查以及术中探查等明确诊断。治疗方式为肝癌切除术＋胆管取栓术，仅行胆管切开取癌栓术及胆管支架置入引流术。结果：19例中7例行手术切除肿瘤＋胆管取癌栓，6例行单纯胆管切开取癌栓，6例仅行胆管支架植入引流术。术后随访至今，其中肿瘤切除＋胆管取癌栓患者平均生存时间超过3年，最长生存时间已超过5年，行胆管切开取癌栓平均生存时间18个月。非手术治疗组仅行胆管支架植入引流术的6例患者生存时间1~13月，平均5.6个月。结论：手术治疗方式是影响肝细胞癌合并胆管癌栓术后预后首要因素。早期诊断、积极切除肿瘤并清除胆管癌栓，术后配合TACE术等综合治疗，是改善预后的有效治疗方法。