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目的 探讨肝细胞癌(HCC)所致的胆管梗阻的影像特点,评估通过ERCP治疗此类患者的疗效。方法 从2000年5月至2003年3月,292例因HCC所致的梗阻性黄疸患者共行ERCP诊疗358例次。患者年龄(51.9±10.6)岁,术前血清总胆红素为(232±158)μmol/L。ERCP时记录下其胆管影像特点,260例接受了内镜下治疗,治疗方法包括括约肌切开及胆管内坏死组织清除、鼻胆管引流术、塑料或金属支架置入和多方法联合应用。观察术后2周内患者体温、胆汁引流量和肝功能的变化,依据这些指标确定疗效。结果 根据放射影像的特点,将患者分成5种类型:Ⅰ型为肝内胆管狭窄或梗阻型(5.9％)、Ⅱ型为肝门部狭窄或梗阻型(19.0％)、Ⅲ型为肝外胆管狭窄或梗阻型(18.4％)Ⅳ型肝门部胆管内癌栓型(49.4％)和Ⅴ型胆管内游离瘤栓型(7.3％)。267例次治疗后患者接受随访,黄疸症状得到有效控制者占82.0％,其中血清胆红素显著降低者为 65.5％。结论 ER-CP对于诊断和姑息性治疗HCC引起的梗阻性黄疸具有积极作用。
Objective To investigate the imaging features of biliary obstruction caused by hepatocellular carcinoma (HCC) and to evaluate the efficacy of ERCP in the treatment of such patients. Methods From May 2000 to March 2003, 292 patients with obstructive jaundice caused by HCC were treated with ERCP for 358 times. The patient’s age was (51.9 ± 10.6) years and preoperative serum total bilirubin was (232 ± 158) μmol / L. ERCP recorded the characteristics of the bile duct images, 260 cases underwent endoscopic treatment, including sphincterotomy and necrotic tissue clearance, biliary drainage, plastic or metal stent placement and multi-method combination. The changes of body temperature, bile drainage and liver function were observed within 2 weeks after operation, and the curative effect was determined according to these indexes. Results According to the characteristics of radiological images, the patients were divided into five types: type Ⅰ intrahepatic bile duct stenosis or obstruction type (5.9%), type Ⅱ hilar stenosis or obstruction type (19.0%), type Ⅲ extrahepatic bile duct Type IV hilar cholangiocarcinoma (49.4%) and type V intra-bile duct embolism (7.3%) were either narrow or obstructive (18.4%). 267 patients were followed up after treatment, jaundice symptoms were effectively controlled accounted for 82.0%, of which serum bilirubin was significantly decreased 65.5%. Conclusion ER-CP has a positive effect on diagnosis and palliative treatment of obstructive jaundice caused by HCC.