Lau W Y, Leow C K, Leung K L, Leung T W, Chan M, Yu S C
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin.
HPB Surg. 2000;11(5):299-306. doi: 10.1155/2000/79241.
In 11 years and 3 months, 2,037 patients with HCC were seen and 48 patients (2.4%) were diagnosed to have obstructive icteric type HCC. Five patients were terminally ill and were not investigated further. Forty three patients were initially investigated by endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangiogram (PTC) and classified as having obstructive icteric type 1, 2, or 3 HCC based on the cholangiographic findings. The obstruction in type 1 HCC was due to intraluminal tumour casts and/or tumour fragments obstructing the hepatic ductal confluence or common bile duct, while intraluminal blood clots, from haemobilia, filling the biliary tree was the cause in type 2 HCC. The pathology in type 3 HCC was extraluminal obstruction by extensive tumour encasement of the intra-hepatic biliary ductal system and/or extrinsic compression of the hepatic and common bile ducts by tumour(s) and/or malignant lymph nodes. At the initial ERC/PTC, 10 patients (5 resected, 50%) had obstructive icteric type 1 and 23 patients (0 resected) had obstructive icteric type 3 HCC. Of the 10 patients initially classified according to cholangiography to have obstructive icteric type 2 HCC, subsequent investigations revealed that 6 patients had type 1 HCC (4 resectable,67%) and 4 patients had type 3 HCC (0 resectable). The classification of the obstructive icteric type HCC into types 1, 2, and 3, based on the initial cholangiographic appearances has simplified and rationalized our management strategy for this condition.
在11年零3个月的时间里，共诊治了2037例肝癌患者，其中48例（2.4%）被诊断为梗阻性黄疸型肝癌。5例患者处于终末期，未作进一步检查。43例患者最初接受了内镜逆行胆管造影（ERC）或经皮经肝胆管造影（PTC）检查，并根据胆管造影结果分为梗阻性黄疸型1、2或3期肝癌。1期肝癌的梗阻是由于管腔内肿瘤栓子和/或肿瘤碎片阻塞肝管汇合处或胆总管，而2期肝癌的梗阻原因是来自胆道出血的管腔内血凝块充满胆管树。3期肝癌的病理表现为肝内胆管系统被广泛肿瘤包绕导致的管腔外梗阻和/或肿瘤和/或恶性淋巴结对肝管和胆总管的外在压迫。在初次ERC/PTC检查时，10例患者（5例接受手术切除，切除率50%）为梗阻性黄疸型1期肝癌，23例患者（0例接受手术切除）为梗阻性黄疸型3期肝癌。在最初根据胆管造影分类为梗阻性黄疸型2期肝癌的10例患者中，后续检查发现6例为1期肝癌（4例可切除，切除率67%），4例为3期肝癌（0例可切除）。根据初次胆管造影表现将梗阻性黄疸型肝癌分为1、2和3期，简化并合理化了我们对这种疾病的治疗策略。
