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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。
Objective To analyze the surgical treatment of obstructive jaundice caused by biliary stricture after transcatheter arterial chemoembolization (TACE). Methods The clinical data of 229 patients with cholangiocarcinoma after TACE treatment of liver cancer from June 1994 to March 2011 in Zhejiang Provincial People’s Hospital and the Second Affiliated Hospital of Zhejiang University Medical College were retrospectively analyzed. 6 cases of primary liver cancer, 3 cases of metastatic liver cancer. Obstructive jaundice occurred in 5 to 16 months after TACE treatment of HCC, with a median time of 8 months. Results Nine cases of obstructive jaundice were found in all the 9 cases of cholangiocarcinoma. Six cases underwent surgery and one case of percutaneous transhepatic cholangiography (PTC) plus biliary stent placed the obstruction relieved. Only two patients underwent percutaneous transhepatic cholangiography (PTCD). Postoperative obstructive jaundice were significantly relieved. Two cases of obstructive jaundice of primary hepatocellular carcinoma after TACE were followed up for 3 years without recurrence of bile duct obstruction and tumor recurrence. The remaining 7 cases were followed up for 3 to 13 months and died of the primary disease worsening. Conclusion Surgical or interventional treatment of obstructive jaundice caused by bile duct stenosis after TACE of hepatocellular carcinoma can obtain good therapeutic effect. According to the site of the primary disease and bile duct obstruction, the range of surgical treatment is decided.