Ueda M, Takeuchi T, Takayasu T, Takahashi K, Okamoto S, Tanaka A, Morimoto T, Mori K, Yamaoka Y
Second Department of Surgery, Faculty of Medicine, College of Medical Technology, Kyoto University, Japan.
Hepatogastroenterology. 1994 Aug;41(4):349-54.
Nine (1.66%) out of 542 cases of HCC treated surgically in our hospital between 1985 and 1992, had macroscopic bile duct thrombi. Three cases presented preoperatively with obstructive jaundice. Two of these received thrombectomy in the hilar bile duct and died of hepatic insufficiency on postoperative days 10 and 66, the other case underwent extended left lobectomy, but also died of renal failure and sepsis 3 months after the operation. In addition, we also treated 6 cases diagnosed at earlier stages than those presenting with obstructive jaundice with both hepatectomy and thrombectomy. In these patients the outcome was as follows: 2 died of recurrent HCC 3 months and 16 months, respectively, after operation, 1 died of apoplexy with no recurrence after 19 months, 1 had a recurrence 5 months after the operation, but is still alive after 7 months, and 2 are still alive 24 months and 60 months after surgery with no recurrence. The outcome is still poor in our series with obstructive jaundice. But in this report, we propose radical surgical treatment for HCC with bile duct thrombi in accordance with our classification, especially for those cases without obstructive jaundice.
1985年至1992年间，我院手术治疗的542例肝癌患者中，有9例（1.66%）出现肉眼可见的胆管血栓。3例术前表现为梗阻性黄疸。其中2例接受了肝门部胆管血栓切除术，分别于术后第10天和第66天死于肝功能不全，另1例接受了扩大左肝叶切除术，但也于术后3个月死于肾衰竭和败血症。此外，我们还治疗了6例比出现梗阻性黄疸的患者诊断更早的病例，均进行了肝切除术和血栓切除术。这些患者的结局如下：2例分别于术后3个月和16个月死于复发性肝癌，1例于19个月后死于中风，无复发，1例术后5个月复发，但7个月后仍存活，2例术后24个月和60个月仍存活，无复发。在我们的系列研究中，梗阻性黄疸患者的结局仍然很差。但在本报告中，我们根据我们的分类方法，建议对伴有胆管血栓的肝癌患者进行根治性手术治疗，尤其是对于那些没有梗阻性黄疸的病例。
