43例原发性肝癌伴胆管梗阻的介入诊疗价值

目的]探讨原发性肝癌伴胆管梗阻的介入诊断与治疗价值。方法]43例原发性肝癌伴胆管梗阻患者，13例行经皮肝穿刺胆管造影（PTC）检查，30例行内窥镜逆行胰胆管造影（ERCP）检查。24例行胆管内支架置入术，39例行经肝动脉化疗栓塞术（TACE）治疗。结果]所有原发性肝癌伴胆管梗阻患者均经PTC或ERCP等影像学检查获得正确诊断。24例患者分别置入了8枚塑料内支架和16枚金属支架，技术成功率为100％。患者术后1周的血清胆红素水平由术前（287±42）μmol／L降（101±50）μmol／L（P〈0．05）。39例患者成功地进行了TACE治疗。结论]PTC和ERCP检查对原发性肝癌伴胆管梗阻有较高的诊断价值，胆道内支架置入术与TACE等介入治疗是其安全有效的治疗方法。

The Value of Interventional Diagnosis a1nd Treatment for 43 Cases with Primary Hepatocellular Carcinoma Complicated with Biliary Obstruction

Purpose ] To investigate the value of interventional diagnosis and treatment for primary hepatocellular carcinoma （PHC） complicated with biliary obstruction. Methods] Among 43 Cases with PHC complicated with biliary obstruction, percutaneous transhepatic cholangiography （PTC） were performed in 13 cases, and endoscopic retrograde cholangiopancreatography （ERCP） in 30 cases. The biliary stent were placed in 24 cases, and the transarterial chemoembolization（TACE） was performed in 39 cases. Results] All cases with PHC obtained correct diagnosis with PTC or ERCP. The plastic stent were placed in 8 patients, metal stent, 16 patients, with implantation successful rate 100%. Serum total bilirubin dropped significantly from （287±42）μmol/L to （101±50）μmol/L after the stent implantation in the first week （P〈0.05）. TACE was performed successfully in 39 cases. Conclusion ] PTC and ERCP have superior diagnostic value for PHC complicated with biliary obstruction. Interventional treatment including stent implantation and TACE is a safe and effective method for PHC complicated with biliary obstruction.