Clinical diagnosis and treatment of hepatocellular carcinoma combined with bile duct tumor thrombi
-
摘要:
目的探讨原发性肝癌合并胆管癌栓临床诊治策略的选择。 方法回顾性分析2016年8月~2019年8月解放军总院海南医院肝胆外科20例原发性肝癌合并胆管癌栓患者的外科诊治情况。 结果20例均行外科手术,4例行左(右)半肝切除+胆管取栓,7例行肝脏肿瘤切除+胆管取栓,4例行肝脏肿瘤射频消融+胆管取栓,3例单纯行胆管切开取栓+T管引流术,2例行经皮经肝胆管引流术。术后随访至今,其中左(右)半肝切除及胆管取栓患者平均生存时间36.2月,肝脏肿瘤切除及胆管取栓平均生存时间34.6月,肝脏肿瘤射频消融及胆管取栓平均生存时间28.2月,单纯行胆管取栓平均生存时间13.6月,经皮经肝胆管引流减黄平均生存时间5.8月。 结论原发性肝癌合并胆管癌栓,早期诊断,积极切除肿瘤及清除胆管癌栓可获得较好的临床疗效。 Abstract:ObjectiveTo evaluate the choice of clinical diagnosis and treatment strategies for hepatocellular carcinoma (HCC) complicated with bile duct tumor thrombi. MethodsA retrospective analysis of the surgical diagnosis and treatment of 20 cases of hepatocellular carcinoma with bile duct tumor thrombi in the hepatobiliary surgery of Hainan Hospital of PLA General Hospital from August 2016 to August 2019. ResultsSurgical operations were performed in all 20 cases. Four cases of left (right) half-hepatectomy+removal of thrombus in bile duct. Seven cases of resection of liver tumor and removal of thrombus in bile duct. Four cases radiofrequency ablation of liver tumors+removal of thrombus in bile duct. Three cases simple bile duct incision and thrombus T tube drainage, percutaneous transhepatic bile duct drainage in 2 cases. Postoperative follow-up to date,the average survival time of patients with left (right) half-hepatectomy and bile duct thrombus removal was 36.2 months. The average survival time of tumor resectionand and bile duct thrombus removal was 34.6 months. The average survival time of radiofrequency ablation and bile duct thrombus removal was 28.2 months. The average survival time of the simple-line bile duct was 13.6 months. The average survival time of percutaneous transhepatic bile duct drainage and yellowing reduction was 5.8 months. ConclusionHepatocellular carcinoma complicated with bile duct tumor thrombus, early diagnosis, active resection of tumor and removal of bile duct tumor thrombi can obtain better clinical effect. -
Key words:
- hepatocellular carcinoma /
- bile duct tumor thrombi /
- surgery
-
表 1 患者预后资料
手术方式 例数(n) 平均生存时间(月) 1年生存率(%) 3年生存率(%) 左右半肝切除+取栓 4 36.2 75.0 50.0 肝脏肿瘤切除+取栓 7 34.6 71.4 42.8 肝癌射频消融+取栓 4 28.0 75.0 50.0 胆总管切开取栓 3 13.6 66.7 0 经皮经肝穿刺胆管引流 2 5.8 0 0 -
[1] 彭淑牖, 王建伟, 刘颖斌, 等. 原发性肝癌伴胆管癌栓的外科治疗[J]. 中华外科杂志, 2003, 41(3): 169-71. doi: 10.3760/j:issn:0529-5815.2003.03.004 [2] Qiao W, Yu F, Wu L, et al. Surgical outcomes of hepatocellular carcinoma with biliary tumor thrombus: a systematic review[J]. BMC Gastroenterol, 2016, 16(2): 11-23. [3] Navadgi S, Chang CC, Bartlett A, et al. Systematic review and meta-analysis of outcomes after liver resection in patients with hepatocellular carcinoma (HCC) with and without bile duct thrombus[J]. HPB (Oxford), 2016, 18(4): 312-6. doi: 10.1016/j.hpb.2015.12.003 [4] 谭蔚锋, 罗祥基, 张柏和, 等. 原发性肝癌合并胆管癌栓不同疗法的效果比较[J]. 中国普通外科杂志, 2008, 17(10): 1033-6. [5] Kim JM, Cho JY, Gwak GY, et al. Incidental microscopic bile duct tumor thrombi in hepatocellular carcinoma after curative hepatectomy: a matched study[J]. Medicine, 2014, 60(1, SI): 874-85. [6] Lin TY, Chen KM, Chen YR, et al. Icteric type hepatoma[J]. Med Chir Dig, 1975, 4(5/6): 267-70. [7] An J, Lee KS, Kim KM, et al. Clinical features and outcomes of patients with hepatocellular carcinoma complicated with bile duct invasion[J]. Clin Mol Hepatol, 2017, 23(2): 160-9. doi: 10.3350/cmh.2016.0088 [8] Shao W, Sui C, Liu Z, et al. Surgical outcome of hepatocellular carcinoma patients with biliary tumor thrombi[J]. World J Surg Oncol, 2011, 9(2): 819-30. [9] Qin LX, Tang ZY. Hepatocellular carcinoma with obstructive jaundice: diagnosis, treatment and prognosis[J]. World J Gastroenterol, 2003, 9(3): 385-91. doi: 10.3748/wjg.v9.i3.385 [10] Peng BG, Liang LJ, Li SQ, et al. Surgical treatment of hepatocellular carcinoma with bile duct tumor thrombi[J]. World J Gastroenterol, 2005, 11(25): 3966-9. doi: 10.3748/wjg.v11.i25.3966 [11] Huang JF, Wang LY, Lin ZY, et al. Incidence and clinical outcome of icteric type hepatocellular carcinoma[J]. Gastroenterol Hepatol, 2002, 17(2): 190-5. doi: 10.1046/j.1440-1746.2002.02677.x [12] Oba A, Takahashi S, Kato Y, et al. Usefulness of resection for hepatocellular carcinoma with macroscopic bile duct tumor thrombus[J]. Anticancer Res, 2014, 34(8): 4367-72. [13] Long XY, Li YX, Wu W, et al. Diagnosis of bile duct hepatocellular carcinoma thrombus without obvious intrahepatic mass[J]. World J Gastroenterol, 2010, 16(39): 4998-5004. doi: 10.3748/wjg.v16.i39.4998 [14] Wu Z, Guo K, Sun H, et al. Caution for diagnosis and surgical treatment of recurrent cholangitis: lessons from 5 cases of bile duct tumor thrombus without a detectable intrahepatic tumor[J]. Medicine, 2014, 93(11): e80-91. doi: 10.1097/MD.0000000000000080 [15] Ueda M, Takeuchi T, Takayasu T, et al. Classification and surgical treatment of hepatocellular carcinoma with bile duct thrombi[J]. Hepatogastroenterol, 1994, 41(5): 349-54. [16] 卢 俊, 于光圣. 肝细胞癌合并胆管癌栓的外科治疗进展[J]. 中国现代普通外科进展, 2009, 12(9): 800-2. doi: 10.3969/j.issn.1009-9905.2009.09.019 [17] Uchima-Koecklin H, Balderramo D, Cárdenas A. Bile duct hepatocellular carcinoma thrombi[J]. Gastroenterol Hepatol, 2012, 35(5): 326-9. doi: 10.1016/j.gastrohep.2011.12.004 [18] 王 坤. 原发性肝癌并胆管癌栓的临床诊治分析: 附19例报告[J]. 现代肿瘤医学, 2017, 25(1): 73-6. doi: 10.3969/j.issn.1672-4992.2017.01.020 [19] Gabata T, Terayama N, Kobayashi S, et al. Mr imaging of hepatocellular carcinomas with biliary tumor thrombi[J]. Abdom Imaging, 2007, 32(4): 470-4. doi: 10.1007/s00261-006-9154-4 [20] Liu QY, Huang SQ, Chen JY, et al. Small hepatocellular carcinoma with bile duct tumor thrombi: CT and MRI findings[J]. Abdom Imaging, 2010, 35(5): 537-42. doi: 10.1007/s00261-009-9571-2 [21] Wong TC, Cheung TT, Chok KS, et al. Outcomes of hepatectomy for hepatocellular carcinoma with bile duct tumour thrombus[J]. HPB (Oxford), 2015, 17(5): 401-8. doi: 10.1111/hpb.12368 [22] Wang C, Yang Y, Sun D, et al. Prognosis of hepatocellular carcinoma patients with bile duct tumor thrombus after hepatic resection or liver transplantation in Asian populations: a meta-analysis[J]. PLoS One, 2017, 12(5): e0176827-38. doi: 10.1371/journal.pone.0176827 [23] Orimo T, Kamiyama T, Yokoo H, et al. Hepatectomy for hepatocellular carcinoma with bile duct tumor thrombus, including cases with obstructive jaundice[J]. Ann Surg Oncol, 2016, 23(8): 2627-34. doi: 10.1245/s10434-016-5174-7 [24] Ikenaga N, Chijiiwa K, Otani K, et al. Clinicopathologic characteristics of hepatocellular carcinoma with bile duct invasion[J]. J Gastrointest Surg, 2009, 13(3): 492-7. doi: 10.1007/s11605-008-0751-0 [25] Xu LB, Wang J, Liu C, et al. Staging systems for predicting survival of patients with hepatocellular carcinoma after surgery[J]. World J Gastroenterol, 2010, 16(41): 5257-62. doi: 10.3748/wjg.v16.i41.5257