原发性肝细胞癌合并胆管癌栓的诊断与治疗

目的：探讨原发性肝细胞癌合并胆管癌栓的诊断与治疗效果.方法：回顾性分析我院49例原发性肝细胞癌合并胆管癌栓的临床特点、诊断和治疗.彩超、CT、MRI等影像学检查是重要的术前诊断措施.24例行根治性切除,25例行姑息性引流或探查手术.结果：MRI具有更高的术前胆管癌栓检出阳性率.围手术期死亡3例,死亡原因为肝功能衰竭2例,肝肾综合征1例.手术并发症14例,经综合治疗后痊愈.42例获得随访,其中根治手术组20例,姑息治疗组22例,随访时间3月-60月.根治手术后1、2、5年累积生存率分别为65.0%,40.0%,12.9%,中位生存时间为21个月;姑息治疗后1、2、5年生存率分别为40.9%、27.3%、0%,中位生存时间为12个月,两组之间1、2、5年累积生存率和中位生存时间差异有统计学意义（P＜0.05）.随访期内死亡的主要原因是肿瘤复发转移.结论：早期诊断、积极采取手术为主的综合治疗是延长原发性肝细胞癌合并胆管癌栓患者生存期的有效手段.

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

Objective： To discuss the diagnosis and the effects of the surgical therapy of primary hepatocellular carcinoma（HCC） with bile duct tumor thrombus. Methods： Retrospective study was performed in 49 cases of HCC with bile duct tumor thrombus who were treated in our hospital between 2000 and 2012. Ultrasound, CT and MRI were important preoperative diagnostic measures. 24 received radical resection and others were performed palliative biliary drainage or ex- ploratory operations. Results： MRI had the higher positive diagnostic rate. The perioperative death ratio was 6. 1% （3/ 49 ）. The cause of death was liver function failure and hepatorenal syndrome. The postoperative complications were found in 14 cases and were cured through comprehensive treatment. 42 cases were followed - up for 3 to 60 months. Among them, 20 received radical resection and 22 had palliative treatment. The 1 - ,2 - and 5 - year cumulative survival rate after radical resection were 65.0%, 40.0% and 12.9% respectively. The 1 - ,2 - and 5 - year cumulative survival rate after palliative treatment were 40.9% , 27.3% , and 0% respectively. There was significant difference between the two groups（P 〈 0.05 ）. The main cause of death was tumor recurrence or metastasis. Conclusion ： Early diagnosis and surgical comprehensive treatment is the effective means for prolonging the survival time of patients.