原发性肝癌伴胆管癌栓的外科治疗

目的　探讨伴胆管癌栓的原发性肝癌 (HCC)外科治疗方式的选择及对预后的影响。方法　回顾性分析 1994～ 2 0 0 1年 15例HCC伴胆管癌栓的外科治疗情况。　结果　肝癌切除加胆管癌栓清除术 7例 ,肝癌切除加肝外胆管切除术 4例 ,单纯胆总管切开取栓术 3例 ,背驮式肝移植 1例。术后 1年生存率为 73 3%,3年生存率为 40 %,其中有 2例生存已超过 5年。门静脉侵犯者的生存率显著低于未侵犯者 (P <0 0 5 )。　结论　原发性肝癌伴胆管癌栓行外科治疗是一种积极有效的治疗方法。复发后选择适当病例再次手术 ,仍可取得较好疗效。肝移植作为一种崭新的手术方式值得探讨。

Surgical intervention of hepatocellular carcinoma with bile duct thrombi

Objectives To summarize the experience of surgical intervention for hepatocellular carcinoma(HCC) with bile duct thrombi(BDT),and to evaluate the influence on prognosis. Methods From 1994 to 2002, 15 patients with HCC and BDT who underwent surgical intervention were retrospectively analyzed. Results The operative procedures included hepatectomy with removal of BDT(n=7), hepatectomy combined with extrahepatic bile duct resection(n=4), thrombectomy through choledochotomy(n=3), and piggy-back orthotopic liver transplantation(n=1). The 1- and 3-year survival rates were 73.3% and 40%,respectively. Two patients survived over 5 year. The survival rate of patients with portal vein invasion was significantly lower than that of patients without portal vein invasion ( P<0.05). Conclusions Surgical intervention was effective for patients with HCC and BDT. Operation after recurrence can prolong the survival time. Liver transplantation is a new operative procedure worthy of study.