肝细胞肝癌合并胆总管癌栓的外科治疗  

Surgical treatment of hepatocellular carcinoma with common bile ducttumor thrombus

作　　者：徐意瑶[1] 卢欣[1] 杨华瑜[1] 桑新亭[1] 赵海涛[1] 杜顺达[1] 徐海峰[1] 迟天毅[1] 毛一雷[1] 钟守先[1] 黄洁夫[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院肝脏外科,北京100730

出　　处：《国际外科学杂志》2014年第5期322-326,F0003,共6页International Journal of Surgery

摘　　要：目的 通过对肝细胞肝癌合并胆总管癌栓手术病例临床资料的回顾性分析,探讨不同手术方式的疗效以及对远期预后的影响.方法 2008年1月-2012年12月,北京协和医院肝脏外科收治肝细胞肝癌合并胆总管癌栓行手术病例共9例,5例病例行根治性半肝切除术,3例行肝部分切除术,1例行术中射频,全部病例均行胆总管探查取栓术;术后通过数字减影血管成像技术进行随诊;全部病例术后随访时间均超过12个月.结果 全部手术病例术后黄疸指数均明显下降,根治性手术病例术后无瘤生存时间、生存时间均略优于姑息手术病例,术后再次胆道梗阻发病率也低于姑息手术病例.结论 肝细胞肝癌合并胆总管癌栓病例通过适当的手术方式可以达到切除肿瘤、解除胆道梗阻的目的,根治性半肝切除术的疗效优于肝部分切除术.Objective To explore the efficacy of different surgical methods and the impact on long-term prognosis,viathe retrospective analysis of surgical patients with hepatocellular carcinoma （HCC） and common bile duct tumor thrombus.Methods From Jan.2008 to Dec.2012,our center treated 9 HCC patients with common bile duct tumor thrombus underwent surgery.5 cases underwent radical half liver resection,3 cases underwent partial hepatectomy,1 case underwent intraoperative radiofrequency,all patients underwent common bile duct exploration thrombectomy.Postoperative follow-up conducted by digital subtraction angiography （DSA）.All patients were followed up for more than 12 months.Results The postoperative jaundice indexes of all the surgical patients were significantly decreased.The diseases free survival time and total survival time of patients underwent radical surgery were slightly better than that of palliative surgical cases.The incidence of postoperative biliary obstruction of patients underwent radical surgery were lower than that of palliative surgical cases.Conclusions HCC patients with common bile duct tumor thrombus through the appropriate surgical methods can achieve the purpose of removal of the tumor and relieve biliary obstruction.The curative effect of radical half liver resection is better than that of partial hepatectomy.

关 键 词：肝细胞肝癌 胆总管癌栓 梗阻性黄疸 肝切除术 疗效比较研究 回顾性研究 

分 类 号：R735.7[医药卫生—肿瘤]