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中国癌症防治杂志

中国癌症防治杂志

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肝细胞癌合并胆管癌栓50例临床诊治分析

桂文波;肖开银;   

  1. 广西医科大学第一附属医院肝胆外科;
  • 收稿日期:2010-09-25 修回日期:2010-09-25 出版日期:2010-09-25 发布日期:2010-09-25

Clinical analysis on 50 cases of hepatocellular carcinoma with bile duct tumor thrombus

GUI Wen-bo,XIAO Kai-yin   

  1. (The First Affiliated Hospital,Guangxi Medical University,Nanning Guangxi 530021,China
  • Received:2010-09-25 Revised:2010-09-25 Online:2010-09-25 Published:2010-09-25

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被引次数

14

摘要： 目的探讨肝细胞癌合并胆管癌栓的临床特点和手术治疗效果。方法回顾性分析我院1998年至2006年50例肝细胞癌合并胆管癌栓的临床特点和手术治疗效果,应用B超、CT、MRCP和AFP等检查以及术中探查等明确诊断,治疗方式为肝癌切除术并胆管癌栓切除、胆管切开取癌栓及胆管支架置入引流术。结果 50例中行根治手术治疗46例,其中肝癌切除术并胆管癌栓切除26例,肝癌切除术并胆管切开取癌栓20例,胆管支架置入引流术4例。全组并发症发生率为26.0%(13/50),术后围手术期死亡率为12.0%(6/50),术后1、2、3年生存率分别为59.1%(26/44)、29.5%(13/44)、20.5%(9/44),最长生存121月,平均19.6月。单因素分析显示影响生存期的因素是AFP定量、肿瘤大小、手术方式及癌栓部位等。多因素分析显示影响生存期的独立因素是手术方式。结论手术治疗方式是影响肝细胞癌合并胆管癌栓术后预后最重要的因素,积极行手术治疗是延长患者生存期的有效手段。

关键词: 肝细胞癌, 胆管癌栓, 诊断与治疗, 预后

Abstract: Objective To investigate clinical feature and the effect of surgical treatment on primary hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDT).MethodsThe clinical feature and effect of surgical treatment on 50 cases of HCC with BDT were analyzed retrospectively.All the patients were treated in our hospital between 1998 and 2006,and were diagnosed through B ultrasound,CT,MRCP,AFP and exploratory celiotomy.Treatments included resection of HCC with BDT,cholangiotomy with BDT resection,and biliary tract prosthesis drainage.Results46 patients received radical operation,which including 26 cases treated by resection of HCC with BDT and 20 cases treated by hepatectomy with BDT clearance.4 cases were treated by biliary tract prosthesis drainage.For all of the patients,the postoperative complications ratio was 26.0% (13/50),and the perioperative death ratio was 12.0% (6/50).The 1-,2-and 3-year actuarial survival were 59.1% (26/44),29.5% (13/44) and 20.5% (9/44) respectively.The average survival time was 19.6 months,with the longest as 121 months.The univariate analysis showed that the factors such as AFP level,tumor size,operation mode and thrombi site could affect survival time significantly.The multivariate analysis showed that the independent predictor for survival time was surgical operation mode.ConclusionsSurgical operation mode is the most important prognostic factor for HCC patient with BDT.Surgical removal of primary tumor and BDT is crucial for prolong patient’s survival time.

Key words: Hepatocellular carcinoma, Bile duct tumor thrombus, Diagnostic and Treatment, Prognosis