肝癌TACE术后胆管狭窄致梗阻性黄疸的外科治疗

摘要

Objective To examine the surgical treatments for obstructive jaundice caused by bile duct strictures after hepat-ic transcatheter arterial chemoembolization(TACE).Methods Clinical data were retrospectively analyzed of 9 patients who de-veloped bile duct strictures among 229 patients after TACE between June 1994 and March 2011 in People’s Hospital of Zhe-jiang Provincial and the Second Affiliated Hospital of Zhejiang University.There were 6 cases of primary liver cancer,and 3 ca-ses of metastatic liver cancer.Obstructive jaundice occurred 5 to 16 months after TACE treatment.The median time was 8 months.Results All the nine patients with bile duct strictures suffered different degrees of obstructive j aundice,which was cured after surgical operations or PTC + stenting in 7 patients and significantly relieved by percutaneous transhepatic cholangic drainage(PTCD)in 2 ones.Two patients with obstructive j aundice after TACE for primary liver cancer were followed up for 3 years,and no recurrence of hepatic carcinoma and bile duct obstruction was found.The other 7 patients were followed up for 3 to 13 months,and they all died of deterioration of primary disease.Conclusion Patients with obstructive jaundice caused by bile duct strictures after TACE benefit from surgical operations or intervention treatment.Different surgical strategies are selected based on the characteristics of primary disease,the site and extent of bile duct stricture.%目的：分析肝癌经导管动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)术后胆管狭窄致梗阻性黄疸的外科治疗方法。方法回顾性分析1994年6月至2011年3月在浙江省人民医院及浙江大学医学院附属第二医院229例因肝癌行肝脏TACE治疗后出现胆管狭窄的9例患者的临床资料。6例为原发性肝癌,3例为转移性肝癌。肝癌经TACE治疗后出现梗阻性黄疸的时间为5~16个月,中位时间为8个月。结果9例胆管狭窄病例均出现不同程度梗阻性黄疸,6例经外科手术,1例经皮肝穿刺胆管造影(PTC)+胆管支架放置治疗使梗阻解除,2例仅行经皮经肝胆管穿刺引流(PTCD)。术后梗阻性黄疸均获得明显缓解。2例原发性肝癌TACE术后梗阻性黄疸随访3年,无胆管梗阻再发和肿瘤的复发；其余7例随访3~13个月,死于原发病恶化。结论手术或介入手段治疗肝癌 TACE 术后胆管狭窄致梗阻性黄疸可以获得良好的治疗效果,根据原发病和胆管梗阻的部位、范围决定外科治疗方式。