CAJ | 학술논문

目的探讨布-加综合征（Budd-Chiari syndrome，B-CS）合并肝细胞肝癌（Hepatocellular carcinoma，HCC）的诊断及治疗方法。方法回顾性分析本院2011年1月至2014年11月收治的33例B-CS合并HCC患者的临床资料。结果 B-CS合并HCC多见于下腔静脉型（8/33）及混合型（24/33）患者。33例患者中5例合并HBV感染，1例合并HCV感染，19例患者血清甲胎蛋白（alpha fetoprotein，AFP）大于400ng/ml。HCC影像学表现为位于肝脏周边及实质内的单发或多发肿物，6例存在门静脉侵犯，1例存在胆管侵犯。治疗上先解除下腔静脉梗阻（3例失败），然后22例行肝动脉化疗栓塞术（Transcatheter arterial chemoembolization，TACE），7例行手术切除，1例先后行TACE及手术切除，3例保守治疗。随访24例，平均随访22.4个月，其中7例死亡，17例生存良好。结论 B-CS并发HCC无特异临床表现，AFP及影像学检查可为诊断提供依据，血管成形联合手术或TACE可获得较好的治疗效果。
목적탐토포-가종합정（Budd-Chiari syndrome，B-CS）합병간세포간암（Hepatocellular carcinoma，HCC）적진단급치료방법。방법회고성분석본원2011년1월지2014년11월수치적33례B-CS합병HCC환자적림상자료。결과 B-CS합병HCC다견우하강정맥형（8/33）급혼합형（24/33）환자。33례환자중5례합병HBV감염，1례합병HCV감염，19례환자혈청갑태단백（alpha fetoprotein，AFP）대우400ng/ml。HCC영상학표현위위우간장주변급실질내적단발혹다발종물，6례존재문정맥침범，1례존재담관침범。치료상선해제하강정맥경조（3례실패），연후22례행간동맥화료전새술（Transcatheter arterial chemoembolization，TACE），7례행수술절제，1례선후행TACE급수술절제，3례보수치료。수방24례，평균수방22.4개월，기중7례사망，17례생존량호。결론 B-CS병발HCC무특이림상표현，AFP급영상학검사가위진단제공의거，혈관성형연합수술혹TACE가획득교호적치료효과。
Objective To explore the diagnosis and treatment of Budd-Chiari syndrome (B-CS) complicated with hepatocellular carcinoma (HCC).Methods The clinical data of 33 patients of B-CS complicated with HCC hospitalized from January 2010 to November 2014 was analysed retrospectively.Results Main forms of the B-CS complicated with HCC were the inferior vena cava obstruction type (8/33) and mixed type (24/33). Among the 33 patients, 5 cases were complicated with HBV infection and 1 case with HCV infection, and the serum alpha fetoprotein (AFP) level was higher than 400ng/ml in 19 cases. Single mass or multiple masses located in the periphery or parenchyma of the liver were discovered on imaging examination, and portal vein invasion was seen in 6 cases and biliary tract invasion was seen in 1 case. The obstructive status of the inferior vena cava of all 33 cases was relievedfirstly (3 cases failed), then 22 cases were treated with transcatheter arterial chemoembolization (TACE), 7 cases with surgical excision, 1 case with TACE and surgical excision sequentially, 3 case with conservative treatment. Among the 24 patients followed up for 22.4 months on average, 7 cases died and 17 cases survived. Conclusions B-CS complicated with HCC has no specific clinical manifestation. AFP level and imaging examination could provide reference points for the diagnosis. Angioplasty combined with surgical excision or TACE could make better outcomes.