论文部分内容阅读
目的探讨经皮经肝穿刺胆管引流术(PTCD)联合经肝动脉内灌注化疗栓塞(TAE)治疗原发性巨块型肝癌合并梗阻性黄疸的方法和临床应用初步效果。方法原发性巨块型肝癌患者25例,其中男性15例,女性10例;年龄35～65岁,平均年龄48岁。因肿瘤压迫或侵蚀胆总管/肝总管合并梗阻性黄疸。在影像诊断明确病变部位和梗阻程度后,先行经皮经肝穿刺胆管(PTC),明确肝胆管侵犯和梗阻细节,酌情置入引流导管行外引流或胆管支架行内引流;术后1周患者黄疸减轻后常规进行肝动脉内介入灌注化疗与栓塞。结果 10例置入外引流管,10例置入胆道支架,5例同时置入外引流管和胆道内支架。引流术后全部外引流病例引流通畅,内引流患者大便色泽改变;血清胆红素、总胆红素下降明显,患者全身状况明显改善。5例出现右侧少量胸腔积液,其他未出现明显并发症。TAE术后肝脏肿块均不同程度缩小(t=10.00,P<0.01)。随访患者最长生存期为3年。结论 PTCD联合TAE治疗原发性肝癌引起的梗阻性黄疸疗效可靠,应根据胆管梗阻部位及程度确定治疗方案,及时施行手术可进一步提高患者生存期。
Objective To investigate the method and clinical application of percutaneous transhepatic biliary drainage (PTCD) combined with transcatheter arterial chemoembolization (TAE) in the treatment of primary giant hepatocellular carcinoma with obstructive jaundice. Methods Twenty-five patients with primary massive liver cancer, including 15 males and 10 females, aged from 35 to 65 years with a mean age of 48 years. Due to tumor compression or erosion of common bile duct / common bile duct obstruction jaundice. After the diagnosis of the lesion and the degree of obstruction, the percutaneous transhepatic cholangiopancreatography (PTC) was first performed to confirm the invasion and obstruction of the hepatobiliary duct. Drainage catheters were inserted or drained, as appropriate, within one week after operation. Jaundice Reduced conventional hepatic artery infusion chemotherapy and embolization. Results Ten cases were placed in the external drainage tube, 10 cases were placed in the biliary stent, and 5 cases were placed in the external drainage tube and the biliary stent. After drainage, drainage of all external drainage cases was unobstructed, and the color of stool changed in patients with internal drainage. Serum bilirubin and total bilirubin decreased significantly, and the general condition of the patients was significantly improved. 5 cases showed a small amount of pleural effusion on the right, the other did not show any significant complications. After TAE, the liver mass was reduced to varying degrees (t = 10.00, P <0.01). Patients were followed up for a maximum of 3 years. Conclusion PTCD combined with TAE treatment of primary liver cancer caused by obstructive jaundice reliable, should be based on the location and extent of bile duct obstruction to determine the treatment plan, and timely operation can further improve the survival of patients.