原发性肝癌伴胆管癌栓的诊治.docVIP

原发性肝癌伴胆管癌栓的诊断及外科治疗 吴晓慧(，(王顺祥，李建坤，彭利，唐瑞峰 河北医科大学第四医院肝胆外科 （石家庄市 050011） 　【摘要】目的 探讨原发性肝癌伴胆管癌栓的诊断及外科治疗方法。方法 回顾性分析7年间收治的20例原发性肝癌伴胆管癌栓的临床资料。结果 术前结合B超、CT确诊9例，肝癌切除加胆总管切开取栓加T管引流术11例，肝癌切除加肝外胆管部分切除加胆管取栓加胆管-空肠端侧吻合术3例，胆总管切开取栓术加T管引流4例，肝内左肝管-十二指肠T管架桥引流2例，术后1，3，5年生存率分别为63.2%，42.1%，15.8%。结论 原发性肝癌伴胆道癌栓早期诊断和外科手术治疗是改善预后的关键。 【关键词】癌，肝细胞； 胆管癌栓； 肝切除术； 诊断　 Diagnosis and surgical treatment of primary liver cancer with bile duct thrombi 　 【Abstract】　Objectives 　To explore the dignosis and surgical treatment for primary liver cancer（PLC) with bile duct thrombi (BDT) , and to evaluate the influence on prognosis. Methods 　From 1998 to2006 , 20 patients with PLC and BDT who underwent surgical treatment were retrospectively analyzed. Results Nine patients with PLC and BDT were diagnosis clearly by ultrasonography or CT. The operative procedures included hepatectomy with removal of BDT(n = 11), hepatectomy combined with extrahepatic bile duct resection and removal of BDT (n = 3), thrombectomy through cholangiotomy ( n = 4). intrahepatic bile duct drainage through duodenum (n = 2).The 1, 3, 5 year survival rates were 63.2%，42.1%，15.8%. Conclusions 　 Early diagnosis and surfical treatment are important to improve prognosis for patients with HCC and BDT. 【Key words】　Carcinoma , hepatocellular ; Bile duct thrombi; Hepatectomy; Diagnosis　 　原发性肝癌（primary liver cancer, PLC)易侵犯门静脉和肝静脉形成癌栓,但合并胆管癌栓（bile duct thrombi，BDT）者罕见,相关报道也较少。本文回顾性分析我院1998～2006年收治的20例PLC伴BDT的诊治情况，现报告如下。 1临床资料 1.1一般资料 本组男18例，女2 例。年龄38～70（平均53.6）岁。临床表现多为黄疸、腹痛、纳差、腹胀不适等。HBsAg阳性16例，甲胎蛋白（AFP）阳性16例，最高达3000μg/L。术前有黄疸16例，胆红素72.1～324.9μmol/L。影像学检查：B超15例，CT20例。 1.2肝癌及胆管癌栓的位置 肿瘤直径2～14cm，平均6.7cm，肿瘤位于肝左叶4例，肝右叶11例，多发占位3例，2例肝内无明确病灶。癌栓位于胆总管及肝总管2例，胆总管4例，肝总管2例，左右肝管及肝总管1例，右肝管7例，右肝管近汇合部1例，右肝管至肝总管1例，左肝管至肝总管2例，并肝硬化者16例，合并门脉癌栓5例。 1.3手术治疗 肝癌切除加胆总管切开取栓加T管引流术11例（门静脉DDS泵置入术），肝癌切除加肝外胆管部分切除加胆管取栓加胆管-空肠端侧吻合术3例，胆总管切开取栓术加T管引流4例（原发灶太大或多发灶），肝内左肝管-十二指肠T管架桥引流2例（肿瘤大，侵及下腔静脉，胆总管挛缩）。本组病人癌栓取出后常规用丝裂霉素10mg加生理盐水100ml反复冲洗胆道。 2结　果 2.1诊断 本组20例中，术前B超显示胆管扩张9例，肝总管或胆总管肿物5例，提示胆管癌栓1