Mok K T, Chang H T, Liu S I, Jou N W, Tsai C C, Wang B W
Department of Surgery, Veterans General Hospital-Kaohsiung, National Yang-Ming University, Taiwan.
Int Surg. 1996 Jul-Sep;81(3):284-8.
Treatment is always abandoned in those HCC with jaundice, because it is usually attributed to the underlying liver cirrhosis and extensive tumor. In this series, 7 cases (0.8%) of HCC with jaundice were caused by bile duct invasion and tumor thrombi (BTT). 57% of cases showed Charcot's triad. 57% of BTT were small HCC, significantly higher than the 1.7% of total cases (p<0.05). The growth pattern of BTT was all spreading type, significantly higher than the 42% of total operation cases (p<0.05). The DNA ploidy of BTT was all aneuploid. 57% of BTT had AFP level higher than 400 IU/ml, but it was 27% in total cases. The prognosis is poor in those treated with palliative tube drainage. Aggressive hepatic resection was proved to be safe and achieved the best results in our limited experience. Choledochotomy to remove tumor thrombi is contraindicated because it easily causes tumor seeding. It is advocated to search BTT for resection from the group of HCC with jaundice.
对于伴有黄疸的肝癌患者，治疗往往会被放弃，因为黄疸通常被认为是由潜在的肝硬化和广泛的肿瘤所致。在本系列研究中，7例（0.8%）伴有黄疸的肝癌是由胆管侵犯和瘤栓（BTT）引起的。57%的病例表现出夏科氏三联征。57%的BTT为小肝癌，显著高于全部病例中的1.7%（p<0.05）。BTT的生长方式均为浸润型，显著高于全部手术病例中的42%（p<0.05）。BTT的DNA倍体均为非整倍体。57%的BTT患者甲胎蛋白水平高于400 IU/ml，但在全部病例中这一比例为27%。采用姑息性置管引流治疗的患者预后较差。在我们有限的经验中，积极的肝切除被证明是安全的且能取得最佳效果。禁忌行胆总管切开取瘤栓，因为这容易导致肿瘤种植播散。主张在伴有黄疸的肝癌患者群体中筛查BTT以便进行切除。
