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目的:探讨胆道支架置放、动脉化疗栓塞(TACE)治疗肝门部肝细胞肝癌(HCC)合并梗阻性黄疸的并发症和疗效。材料和方法:83例肝门部HCC合并梗阻性黄疸患者经皮穿肝胆道引流后放置胆道支架,部分患者接受TACE,观察手术并发症,血清胆红素下降情况,随访黄疸复发时间和患者生存期。结果:83例共计放置支架97枚,其中14例放置2枚支架,其中连续重叠置放4例,“Y”型置放9例,“T”型置放1例。术后胆道出血5例;胆道感染9例,9例中2例形成肝脓肿。83例中,39例接受TACE术共计70次,术后1例出现肝功能衰竭,2例出现胆囊炎。83例患者血清总胆红素浓度由术前263.7μmol/L降至术后69.2μmol/L(t=10.312,P<0.05)。1例患者于术后1月死于肝功能衰竭,2例死于食管胃底静脉破裂出血,6例失访。83例生存期1～72个月,平均7.9个月,中位值6.0个月。43例黄疸复发,复发率51.8%,黄疸复发时间1～20个月,平均13.6个月,中位值6.0个月。结论:胆道支架置放、TACE治疗肝门部HCC合并梗阻性黄疸患者有较好疗效。左右肝管分别梗阻的病例,“Y”型置放支架较“T”型更合理。
Objective: To investigate the complications and curative effects of biliary stent placement and arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) complicated with obstructive jaundice in hilar. MATERIALS AND METHODS: Totally 83 patients with hilar HCC complicated with obstructive jaundice were placed percutaneous transhepatic biliary drainage, and some patients underwent TACE. The complications, the decline of serum bilirubin, follow-up time of jaundice recurrence and patient survival period. Results: A total of 97 stents were placed in 83 cases, of which 14 were placed in two stents, of which 4 were placed in succession, 9 in “Y” type and 1 in “T” type. 5 cases of postoperative biliary bleeding; 9 cases of biliary tract infection, 2 cases of 9 cases of liver abscess formation. Of 83 cases, 39 received TACE for a total of 70 times. One case had liver failure and two cases had cholecystitis. The serum total bilirubin concentration in 83 patients decreased from 263.7μmol / L to 69.2μmol / L preoperatively (t = 10.312, P <0.05). One patient died of liver failure at 1 month after operation, 2 died of esophageal-gastric variceal bleeding, and 6 patients lost follow-up. 83 cases of survival of 1 to 72 months, an average of 7.9 months, the median 6.0 months. 43 cases of jaundice recurrence, the recurrence rate was 51.8%, jaundice recurrence time of 1 to 20 months, an average of 13.6 months, a median of 6.0 months. Conclusion: Biliary stent placement, TACE treatment of hilar HCC with obstructive jaundice has a good effect. Left and right hepatic duct obstruction cases, “Y” type stent is more reasonable than the “T” type.