Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Eur J Gastroenterol Hepatol. 2011 Mar;23(3):224-31. doi: 10.1097/MEG.0b013e3283436ff6.
The prognosis of patients with obstructive jaundice caused by hepatocellular carcinoma (HCC) has been reported to be poor. The aims of this study were to determine whether effective biliary drainage in patients with obstructive jaundice caused by HCC can affect clinical outcome and to identify those factors that affect effective biliary drainage and clinical outcome.
The clinical records of 68 patients with obstructive jaundice caused by HCC who underwent endoscopic or percutaneous transhepatic biliary drainage from 1 January 2004 to 31 December 2008 were analyzed. Effective biliary drainage was defined as a decrease in total bilirubin level of more than 30% of the preprocedural value within 4 weeks.
(i) Effective biliary drainage was achieved in 51.5% of the patients who underwent a biliary drainage procedure. The independent risk factors for ineffective biliary drainage were total bilirubin more than 13 mg/dl and Child-Turcotte-Pugh class C. (ii) Patients with effective biliary drainage showed a significant improvement of Child-Turcotte-Pugh class and received additional treatment for HCC. (iii) The mean survival times of patients who received effective or ineffective biliary drainage were 247 and 44 days, respectively. (iv) The independent risk factors of mortality were an age of more than 63 years, ineffective biliary drainage, and no following treatment for HCC.
When effective biliary drainage was achieved after an appropriate biliary drainage procedure in patients with obstructive jaundice caused by HCC, survival improved.
肝细胞癌（HCC）所致阻塞性黄疸患者的预后一直被认为较差。本研究旨在确定有效胆道引流是否会影响 HCC 所致阻塞性黄疸患者的临床结局，并确定影响有效胆道引流和临床结局的因素。
分析了 2004 年 1 月 1 日至 2008 年 12 月 31 日期间接受内镜或经皮经肝胆道引流的 68 例 HCC 所致阻塞性黄疸患者的临床记录。有效胆道引流定义为 4 周内总胆红素水平较术前值下降 30%以上。
（i）接受胆道引流的患者中，51.5%的患者实现了有效胆道引流。无效胆道引流的独立危险因素是总胆红素>13mg/dl 和 Child-Turcotte-Pugh 分级 C。（ii）实现有效胆道引流的患者的 Child-Turcotte-Pugh 分级显著改善，并接受了 HCC 的额外治疗。（iii）接受有效或无效胆道引流的患者的平均生存时间分别为 247 天和 44 天。（iv）死亡的独立危险因素是年龄>63 岁、无效胆道引流和未接受 HCC 后续治疗。
在 HCC 所致阻塞性黄疸患者中，适当的胆道引流术后如果能实现有效胆道引流，则生存时间会延长。
