原发性肝细胞癌合并胆管癌栓的外科诊治分析

目的探讨原发性肝细胞癌合并胆管癌栓的诊断及外科治疗效果。方法回顾性总结和分析20例原发性肝细胞癌合并胆管癌栓的外科诊治情况。采用肝叶切除及癌栓取出术7例、单纯胆管癌栓取出3例;肝动脉化疗栓塞术(transcatheter hepatic arterial chemoembolization,TACE)后肝切除加癌栓取出术10例。术后均行胆管引流及TACE。结果术前行TACE的10例患者,术中胆道出血(45.2±12.5)ml,明显少于未行TACE者(90.5±10.5)ml,差异显著(P0.05)。全部病例均获随访,平均时间22(2～54)个月。肝叶切除及癌栓取出7例,平均生存(21.5±2.8)个月;术前TACE、2周后行肝叶切除加癌栓取出10例,平均生存(28.5±3.1)个月;单纯癌栓取出3例,平均生存(4.1±0.5)个月,术前行TACE组生存时间明显长于其余两组(P0.05)。结论对原发性肝细胞癌合并胆管癌栓早期诊断、积极切除肿瘤并清除胆管癌栓,配合术前术后TACE术,是改善预后的有效治疗方法。

Diagnosis and Surgical Treatment of the Bile Duct Tumor Thrombus in 20 Patients with Primary Hepatocellular Carcinoma

Objective To evaluate the diagnosis and the effects of the surgical therapy for primary hepatocellular carcinoma（HCC） with bile duct tumor thrombus（BDT）.Methods Retrospective study was performed in 20 cases of HCC with BDT.Hepatectomy and choledochotomy with preoperative TACE was performed in 10 cases.All the cases received biliary duct drainage and TACE after operation.Results The intraoperative biliary tract blood loss in the 10 cases of preoperative TACE was（45.2±12.5）ml,which was significantly less than the non-TACE patients（P0.05）.All cases were followed up.The average survival time of 7 cases who received hepatectomy and BDT clearance was（21.5±2.8）months.The survival time of 10 cases who received hepatectomy and BDT clearance two weeks after preoperative TACE was（28.5±3.1）months.The survival time of 3 cases who received BDT clearance was（4.1±0.5）months.The survival time of the hepatectomy and BDT clearance combined with preoperative TACE was longer than the other groups（P0.05）.Conclusion Early diagnosis,surgical removal of primary tumors and BDT,and pre-and postoperative TACE are effective for the patients of HCC with BDT.