华中科技大学学报（医学版）
華中科技大學學報（醫學版）
화중과기대학학보（의학판）
ACTA UNIVERSITATIS MEDICINAE TONGJI
2014年
4期
441-443,448
,共4页
肝癌%经导管动脉栓塞化疗%胆管狭窄
肝癌%經導管動脈栓塞化療%膽管狹窄
간암%경도관동맥전새화료%담관협착
hepatic carcinoma%transcatheter arterial chemoembolization%bile duct stricture
目的：分析肝癌经导管动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)术后胆管狭窄致梗阻性黄疸的外科治疗方法。方法回顾性分析1994年6月至2011年3月在浙江省人民医院及浙江大学医学院附属第二医院229例因肝癌行肝脏TACE治疗后出现胆管狭窄的9例患者的临床资料。6例为原发性肝癌,3例为转移性肝癌。肝癌经TACE治疗后出现梗阻性黄疸的时间为5~16个月,中位时间为8个月。结果9例胆管狭窄病例均出现不同程度梗阻性黄疸,6例经外科手术,1例经皮肝穿刺胆管造影(PTC)+胆管支架放置治疗使梗阻解除,2例仅行经皮经肝胆管穿刺引流(PTCD)。术后梗阻性黄疸均获得明显缓解。2例原发性肝癌TACE术后梗阻性黄疸随访3年,无胆管梗阻再发和肿瘤的复发；其余7例随访3~13个月,死于原发病恶化。结论手术或介入手段治疗肝癌 TACE 术后胆管狭窄致梗阻性黄疸可以获得良好的治疗效果,根据原发病和胆管梗阻的部位、范围决定外科治疗方式。
目的：分析肝癌經導管動脈栓塞化療(transcatheter arterial chemoembolization,TACE)術後膽管狹窄緻梗阻性黃疸的外科治療方法。方法迴顧性分析1994年6月至2011年3月在浙江省人民醫院及浙江大學醫學院附屬第二醫院229例因肝癌行肝髒TACE治療後齣現膽管狹窄的9例患者的臨床資料。6例為原髮性肝癌,3例為轉移性肝癌。肝癌經TACE治療後齣現梗阻性黃疸的時間為5~16箇月,中位時間為8箇月。結果9例膽管狹窄病例均齣現不同程度梗阻性黃疸,6例經外科手術,1例經皮肝穿刺膽管造影(PTC)+膽管支架放置治療使梗阻解除,2例僅行經皮經肝膽管穿刺引流(PTCD)。術後梗阻性黃疸均穫得明顯緩解。2例原髮性肝癌TACE術後梗阻性黃疸隨訪3年,無膽管梗阻再髮和腫瘤的複髮；其餘7例隨訪3~13箇月,死于原髮病噁化。結論手術或介入手段治療肝癌 TACE 術後膽管狹窄緻梗阻性黃疸可以穫得良好的治療效果,根據原髮病和膽管梗阻的部位、範圍決定外科治療方式。
목적：분석간암경도관동맥전새화료(transcatheter arterial chemoembolization,TACE)술후담관협착치경조성황달적외과치료방법。방법회고성분석1994년6월지2011년3월재절강성인민의원급절강대학의학원부속제이의원229례인간암행간장TACE치료후출현담관협착적9례환자적림상자료。6례위원발성간암,3례위전이성간암。간암경TACE치료후출현경조성황달적시간위5~16개월,중위시간위8개월。결과9례담관협착병례균출현불동정도경조성황달,6례경외과수술,1례경피간천자담관조영(PTC)+담관지가방치치료사경조해제,2례부행경피경간담관천자인류(PTCD)。술후경조성황달균획득명현완해。2례원발성간암TACE술후경조성황달수방3년,무담관경조재발화종류적복발；기여7례수방3~13개월,사우원발병악화。결론수술혹개입수단치료간암 TACE 술후담관협착치경조성황달가이획득량호적치료효과,근거원발병화담관경조적부위、범위결정외과치료방식。
Objective To examine the surgical treatments for obstructive jaundice caused by bile duct strictures after hepat-ic transcatheter arterial chemoembolization(TACE).Methods Clinical data were retrospectively analyzed of 9 patients who de-veloped bile duct strictures among 229 patients after TACE between June 1994 and March 2011 in People’s Hospital of Zhe-jiang Provincial and the Second Affiliated Hospital of Zhejiang University.There were 6 cases of primary liver cancer,and 3 ca-ses of metastatic liver cancer.Obstructive jaundice occurred 5 to 16 months after TACE treatment.The median time was 8 months.Results All the nine patients with bile duct strictures suffered different degrees of obstructive j aundice,which was cured after surgical operations or PTC + stenting in 7 patients and significantly relieved by percutaneous transhepatic cholangic drainage(PTCD)in 2 ones.Two patients with obstructive j aundice after TACE for primary liver cancer were followed up for 3 years,and no recurrence of hepatic carcinoma and bile duct obstruction was found.The other 7 patients were followed up for 3 to 13 months,and they all died of deterioration of primary disease.Conclusion Patients with obstructive jaundice caused by bile duct strictures after TACE benefit from surgical operations or intervention treatment.Different surgical strategies are selected based on the characteristics of primary disease,the site and extent of bile duct stricture.
