Caution for diagnosis and surgical treatment of recurrent cholangitis: lessons from 5 cases of bile duct tumor thrombus without a detectable intrahepatic tumor.
Caution for diagnosis and surgical treatment of recurrent cholangitis: lessons from 5 cases of bile duct tumor thrombus without a detectable intrahepatic tumor.
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注意复发性胆管炎的诊断和手术治疗：5例胆管肿瘤血栓的经验教训，没有可检测的肝内肿瘤。
DOI：
10.1097/md.0000000000000080
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发表时间：
2014-09
期刊：
影响因子：
1.6
通讯作者：
Wang B
中科院分区：
文献类型：
--
作者：
Wu Z;Guo K;Sun H;Yu L;Lv Y;Wang B
肝细胞癌（HCC）合并胆管癌栓（BDTT）的患者早期临床症状无特异性。当肝内肿瘤较小，甚至无法检出时，HCC合并BDTT常被误诊。本文报告5例原发性肝癌合并胆管癌栓在当地医院误诊为胆总管结石和胆管炎的病例。我们回顾性分析了5年来在当地医院误诊的5例HCC合并BDTT患者，并总结了经验。本文讨论其诊断、治疗及预后。3例患者接受了肝切除术联合血栓切除术和T管引流。1例行肝切除胆总管切除肝空肠吻合术，1例门静脉癌栓合并肝内转移行姑息性手术。随访6-22个月，4例患者死于肿瘤复发转移或肝功能衰竭，其中3例患者接受了经肝动脉化疗栓塞或射频消融治疗。BDTT对HCC的早期准确诊断具有重要意义。当患者有异常复发性胆管炎病史时，应高度怀疑HCC伴BDTT。导管内超声检查、术中超声检查和组织病理学检查对诊断有重要价值。HCC患者合并BDTT的预后很差。识别这种类型的患者在临床上是重要的，因为手术治疗可能是有益的。
The hepatocellular carcinoma (HCC) patients with bile duct tumor thrombus (BDTT) usually have no specific clinical symptoms at early stages. HCC with BDTT was usually misdiagnosed when the intrahepatic tumor was small, even undetectable. In this study, 5 cases of HCC with BDTT misdiagnosed as choledocholithiasis and cholangitis in the local hospital are described. We analyzed retrospectively and summarized our experiences of these 5 HCC patients with BDTT misdiagnosed in the local hospital during the past 5 years. The diagnosis, treatment, and outcome of the patients are discussed. Three patients underwent hepatectomy with thrombectomy and T-tube drainage. One patient underwent hepatectomy with the resection of the common bile duct and hepatojejunostomy, and palliative surgery was performed in 1 patient with portal vein tumor thrombus and intrahepatic metastasis. The patients were followed for 6–22 months; 4 patients died of tumor recurrence and metastasis or hepatic failure, despite 3 of these patients having received transhepatic arterial chemotherapy and embolization or radiofrequency ablation therapy. Early and accurate diagnosis of HCC with BDTT is very important. When patients have a history of abnormal recurrent cholangitis, HCC with BDTT should be highly suspected. Intraductal ultrasonography (US), intraoperative US, and histopathological examination are very valuable for the diagnosis. The prognosis of HCC patients with BDTT is dismal. Identification of this type of patient is clinically important, because surgical treatment may be beneficial.