Oshima S, Okayasu I, Hatakeyama S
Bull Tokyo Med Dent Univ. 1986 Jun;33(2):91-7.
Two rare cases of autopsy and surgery presenting extrahepatic biliary obstruction due to intrabile-duct growth of hepatocellular carcinoma were reported. Clinically obstructive jaundice was predominant in comparison with the other symptoms in both cases. In one autopsy case, hepatocellular carcinoma developed in the right lobe of the cirrhotic liver (posthepatitic). It involved the secondary branch of the right hepatic duct and grew into the common hepatic duct. In the other case of surgical operation, hepatocellular carcinoma, which developed in the posterior portion of the right lobe of the cirrhotic liver (posthepatitic), destroyed the posterior wall of the bifurcation of the bilateral hepatic duct and obstructed the common hepatic duct due to the intraductal cancer growth. From the site of the bile duct invasion or permeation by the tumor, two cases were classified into the peripheral (the former case) and proximal (the latter case) types, respectively. Furthermore, as far as obstructive jaundice is clinically concerned, the possibility should be kept in mind that hepatocellular carcinoma may proliferate into the large bile ducts, apart from that of cholangiocarcinoma or cholelithiasis.
报告了两例罕见的尸检和手术病例，均因肝细胞癌在胆管内生长导致肝外胆管梗阻。两例临床症状均以梗阻性黄疸为主，其他症状相对少见。其中一例尸检病例中，肝细胞癌发生于肝硬化（肝炎后）肝脏右叶，累及右肝管二级分支并长入肝总管。另一例手术病例中，肝细胞癌发生于肝硬化（肝炎后）肝脏右叶后部，破坏了双侧肝管分叉处后壁，因肿瘤在胆管内生长导致肝总管梗阻。根据肿瘤侵犯或浸润胆管的部位，两例分别被归类为外周型（前一例）和近端型（后一例）。此外，就临床梗阻性黄疸而言，应牢记肝细胞癌除了胆管癌或胆石症外，也可能向大胆管内增殖。
