19%～40%肝细胞癌患者合并有黄疸.肝细胞癌相关黄疸根据其不同的病理生理机制而分为肝细胞性和梗阻性黄疸2类.梗阻性黄疸是由癌栓、凝血块、胆泥肿瘤压迫或侵犯造成胆管梗阻引起.黄疸及上腹部不适为主要临床表现.本例合并梗阻性黄疸的肝细胞癌患者以重症急性胰腺炎和胆管炎为首发症状,肿瘤位于肝中叶,癌栓位于胆总管下端,非常罕见.通过治愈性肝肿瘤切除联合胆总管探查治疗,患者痊愈出院,随访3年无复发.%Jaundice occurs in 19％-40％ of the hepatocellular carcinoma (HCC) patients.HCC associated jaundice may be divided into hepatocellular and icteric types in terms of its underlying pathophysiology. The jaundice of icteric type is caused by obstruction of the bile duct through cancer embolus, blood clot, biliary sludge, tumor compression or infiltration. Jaundice and epigastric discomforts are the main clinical manifestations. In the present case, severe acute pancreatitis and acute cholangitis presenting as initial complaints of icteric type HCC were quite rare. A tumor located at the central lobe of the liver and a cancer embolus at the lower part of the common bile duct (CBD) were detected by CT scan. Curative resection of HCC with CBD exploration eradicated both the tumor and the embolus, and no recurrence was found after a 36 month follow-up.
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