肝细胞癌并发梗阻性黄疸的介入治疗

目的评价介入治疗对于肝细胞癌（HCC）并发梗阻性黄疸的疗效。方法对12例HCC伴发梗阻性黄疸接受介入治疗的患者，首先行PTBD，左侧人路3例，右侧2例，双侧人路7例。在PTC显示胆管形态恢复正常后，8例留置内支架（覆膜支架12枚，裸支架2枚）．另4例单纯留置胆道引流管姑息治疗。结果PTBD成功率100％，4例并发胆管内出血。10例行胆管引流术1周后，血清总胆红素下降50％以上，肝功能好转．另2例在引流2周时血清总胆红素下降50％以上。生存时间自首次PTBD时间起3～13个月．平均生存时间6．2个月，6个月生存率41．67％，1年生存率16．67％。留置内支架的病例平均生存时间为6．52个月，仅行引流术而未植入内支架的病例平均生存时间为6．05个月，二者无显著统计学差异（P〉0．05）。7例患者接受经肝动脉化疗栓塞术治疗未发生并发症。结论有效的胆道引流是治疗HCC合并梗阻性黄疸的关键。胆管引流术和胆道内支架留置术都是有效的治疗方法，能够延长生存时间，创造进一步治疗机会。

Interventional treatment for obstructive jaundice caused by hepatocellular carcinoma

Objective To evaluate the efficacy and outcome of interventional treatment in patients with obstructive jaundice caused by hepatocellular carcinoma(HCC).Methods The data of 12 HCC patients with obstructive jaundice who underwent interventional treatments were reviewed retrospectively.Five patients manifested obstructive jaundice as the initial complaint and other 7 patients had received TACE treatment for 3 to 5 times.All patients underwent PTBD firstly,8 patients were treated with metallic stent palacement when PTC showed the shape of bile duct was normal,while the rest 4 patients received palliative biliary drainage alone.The level of total serum bilirubin(Tbil) and Child-Pugh score before and 1 week after PTBD were compared.The survival time of 4 cases underwent palliative biliary drainage alone were compared with those underwent stent placements.Results The technical success rate of PTBD was 100%.Decreasing of Tbil more than 50% was achieved in all patients within 2 weeks.The survival time of 4 cases underwent PTBD alone ranged from 3 to 13 months(median 6.2 months),of 8 cases who received stents placement ranged from 3 to 13 months(median survival of 6.2 months,P>0.05).Mortality of all patients was 41.67% at 6 months and 16.67% at 12 months,respectively.No complication occurred in the 7 patients who received TACE treatment.Conclusion Effective biliary drainage may be the key point of prolonging the survival time,while both PTBD and stent placement is effective treatment for patients of HCC with obstructive jaundice.