原发性肝细胞癌合并胆管癌栓的外科诊治分析

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1、中国现代手术学杂志2010年8月第14卷第4期251[文章编号]1009—2188(2010)04—0251—03临床论著·原发性肝细胞癌合并胆管癌栓的外科诊治分析孙自强，赵文华，张波，于文胜，石学涛，李胜(1．山东省济宁医学院附属医院肝胆血管外科，济宁272029；2．山东省千佛山医院肿瘤科，济南250014；3．山东省肿瘤防治研究院肝胆外科，济南250117)[摘要]目的探讨原发性肝细胞癌合并胆管癌栓的诊断及外科治疗效果。方法回顾性总结和分析20例原发性肝细胞癌合并胆管癌栓的外科诊治情况。采用肝叶切除

2、及癌栓取出术7例、单纯胆管癌栓取3例；肝动脉化疗栓塞术(transeatheterhepaticarterialehemoembolization，TACE)后肝切除加癌栓取出术l0例。术后均行胆管引流及TACE。结果术前行TACE的l0例患者，术中胆道出血(45．2±12．5)ml，明显少于未行TACE者(9O．5-4-10．5)ml，差异显著(P<0．05)。全部病例均获随访，平均时间22(2～54)个月。肝叶切除及癌栓取出7例，平均生存(21．5±2．8)个月；术前TACE、2周后行肝叶切除加癌栓取

3、出10例，平均生存(28．5±3．1)个月；单纯癌栓取出3例，平均生存(4．1±0．5)个月，术前行TACE组生存时间明显长于其余两组(P<0．05)。结论对原发性肝细胞癌合并胆管癌栓早期诊断、积极切除肿瘤并清除胆管癌栓，配合术前术后TACE术，是改善预后的有效治疗方法。[关键词]肝肿瘤；胆管；肝切除；肿瘤循环细胞[中图分类号]R735．7[文献标识码]BDiagnosisandSurgicalTreatmentoftheBileDuctTumorThrombusin20PatientswithPrima

4、ryHepa-tocellularCarcinomaSUNZi—qiang，ZHAOWen—hua，ZHANGBo，YUWen—sheng，SHIXue—tao，LISheng(DepartmentofHepatobiliaryandVascularSurgery，theAffiliatedHospitalofJiningMedicalCollege，Jining272029，Shandong，China)Abstract：ObjectiveToevaluatethediagnosisandtheeffe

5、ctsofthesurgicaltherapyforprimaryhepato—cellularcarcinoma(HCC)withbileducttumorthrombus(BDT)．MethodsRetrospectivestudywasper—formedin20casesofHCCwithBDT．HepatectomyandeholedochotomywithpreoperativeTACEwasperformedin10cases．A11theeasesreceivedbiliaryductdr

6、ainageandTACEafteroperation．ResultsTheintraoperativebiliarytractbloodlossinthe10casesofpreoperativeTACEwas(45．2±12．5)nd，whichwassignificantlylessthanthenon—TACEpatientsfP<0．05)．Allcaseswerefollowedup．Theaveragesurvivaltimeof7easeswhore—ceivedhepatectomyan

7、dBDTclearancewas(21．5±2．8)months．Thesurvivaltimeof10caseswhoreceivedhepa—tectomyandBDTclearancetwoweeksafterpreoperativeTACEWas(28．54-3．1)months．Thesurvivaltimeof3ca—seswhoreceivedBDTclearancewasf4．1±0．5months．ThesurvivaltimeofthehepatectomyandBDTclearanc

8、ecombinedwithpreoperativeTACEWaslongerthantheothergroups(P<0．05)．ConclusionEarlydiagnosis．Sill"一gicalremovalofprimarytumorsandBDT，andpre—andpostoperativeTACEareefectiveforthepatientsofHCCwithBDT．Keywords：liverneopla