| 华允强,杨辰欣,由法平,等.胆管癌栓梗阻为突出表现的肝细胞癌 1例[J].安徽医药,2025,29(11):2268-2271. |
| 胆管癌栓梗阻为突出表现的肝细胞癌 1例 |
| Hepatocellular carcinoma with obstruction of bile duct tumor thrombus as a prominent manifestation: a case report |
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| DOI：10.3969/j.issn.1009-6469.2025.11.032 |
| 中文关键词: 癌，肝细胞 栓塞 胆管梗阻 胆汁淤积 癌栓 胆管扩张 误诊 |
| 英文关键词: Carcinoma, hepatocellular Embolism Bile duct obstruction Cholestasis Tumor thrombus Cholangiectasis Diagnostic errors |
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| 中文摘要: |
| 目的探索肝细胞癌合并胆管癌栓诊断经验。方法总结分别于 2020年 11月、 2020年 12月、 2021年 1月被胜利油田中心医院收治的 1例因多次胆管癌栓梗阻诊断出肝细胞癌病人的诊疗过程。结果病人因上腹部疼痛不适 3次入院， 3次入院均未发现肝脏明显的占位性原发灶。第 1次入院术前诊断胆总管结石并胆管炎、胆囊结石并胆囊炎，行腹腔镜联合胆道镜胆总管切开取石、胆囊切除、 T管引流术。第 2次入院给予对症保肝、抗感染治疗症状缓解。第 3次入院于超声引导下对梗阻部位的肝脏行穿刺活检术，病理结果证实为肝细胞癌。行腹腔镜下肝脏 Ⅴ、Ⅷ段切除、胆总管切开探查、 T管引流术。术后病理证实胆管内肿物为肝细胞癌组织，病人恢复良好，门诊随访病情稳定，未见复发征象。结论胆管癌栓的发现可早于肝细胞癌原发灶；对于乙型肝炎病人反复出现阻塞性黄疸、胆管炎，不论肝内有无原发灶发现，皆应警惕胆管癌栓存在。 |
| 英文摘要: |
| Objective To explore the experience of diagnosis of hepatocellular carcinoma complicated with bile duct tumor thrombus. Methods The diagnosis and treatment process of a patient with hepatocellular carcinoma diagnosed as multiple bile duct cancer em-bolism was summarized in November 2020, December 2020 and January 2021 at Shengli Oilfield Central Hospital.Results The pa-tient was admitted three times due to epigastric pain and discomfort, and no obvious mass primary lesion of the liver was found on allthree admissions. Before the first admission, the diagnosis was common bile duct stones with cholangitis and gallbladder stones withcholecystitis. Laparoscopy combined with choledochoscopy was performed for common bile duct incision and stone removal, cholecys-tectomy, and T-tube drainage. The symptoms were relieved after the second admission and symptomatic liver-protecting and anti-infec-tion treatment. On the third admission, a biopsy was performed on the obstructed liver under ultrasound guidance, and the pathologicalresult confirmed hepatocellular carcinoma. Laparoscopic resection of liver segments Ⅴ and Ⅷ, common bile duct incision and explora-tion, and T-tube drainage were performed. Postoperative pathology confirmed that the mass in the bile duct was hepatocellular carcino-ma. The patient recovered well. During the outpatient follow-up, the condition was stable and no signs of recurrence were observed. Conclusion The detection of bile duct tumor thrombus can be earlier than the primary lesion of hepatocellular carcinoma, and pa-tients with recurrent obstructive jaundice and cholangitis in patients with hepatitis B, regardless of whether there is a primary lesion inthe liver, should be vigilant for the presence of bile duct tumor thrombus. |
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