中国普外基础与临床杂志

中国普外基础与临床杂志

多学科诊疗模式治疗“梗阻性黄疸伴肝门胆管占位”病例报道

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目的 以多学科诊疗模式讨论 1 例“梗阻性黄疸伴肝门胆管占位”患者的个体化治疗。 方法 采用多学科诊疗模式对四川省肿瘤医院于 2017 年 5 月收治的 1 例“梗阻性黄疸伴肝门胆管占位”患者进行诊断、围手术期处理以及手术治疗方案的制定,实现肝癌患者的个体化治疗。 结果 患者因“梗阻性黄疸伴肝门胆管占位”就诊,门诊误诊为“肝门胆管癌”并收治入院,通过多学科诊疗模式修正诊断为“肝细胞癌伴胆总管癌栓”。多学科诊疗模式讨论认为,肝癌伴胆管癌栓虽是肝癌的晚期表现,但结合目前的研究进展建议积极采取手术切除治疗。治疗计划及方案包括:首先对患者进行经皮肝穿右侧胆道引流;待胆道引流 1 个月、肝功能恢复后进行肝癌切除联合胆总管及癌栓切除。该患者成功实施胆道引流以及手术切除,手术顺利,术后恢复可,随访半年后复查未见肿瘤复发。 结论 多学科诊疗模式不但可减少“梗阻性黄疸伴肝门胆管占位”的误诊,同时可使患者获得最佳治疗和个体化治疗方案。

Objective To diagnose and treat a patient with obstructive jaundice and hepatic bile duct tumor by multi-disciplinary team and to provide individualized treatment. Methods By multi-disciplinary team model, a patient with obstructive jaundice and hepatic bile duct tumor, who was ever misdiagnoseed as hilar cholangiocarcinoma, was discussed. The diagnosis, perioperative period management, and operation scheme were carried out by the team. Results After multi-disciplinary team discussion, the patient was diagnosed as " hepatocellular carcinoma with bile duct tumor thrombi”, not " hilar cholangiocarcinoma”. Although hepatocellular carcinoma with bile duct tumor thrombi was end-stage disease, radical treatment was still considered. A plan of treatment was carried out by the team. Firstly, the percutaneous transhepatic cholangial drainage was operated for the predicted reserved half liver to relieve biliary obstruction. Secondly, hemihepatectomy combined with bile duct resection was carried out by the surgery team. The patients had nice postoperative recovery and there was no tumor recurrence after 6-month follow-up after surgery up to now. Conclusions Multi-disciplinary team model do not only reduce misdiagnose, but also can provide the best therapeutic regimen and individualized treatment for patient presented with obstructive jaundice and hepatic bile duct tumor.

关键词: 肝细胞癌; 胆管癌栓; 肝切除; 多学科诊疗模式

Key words: hepatocellular carcinoma; bile duct tumor thrombi; hepatectomy; multi-disciplinary team

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1. Kasai Y, Hatano E, Seo S, et al. Hepatocellular carcinoma with bile duct tumor thrombus: surgical outcomes and the prognostic impact of concomitant major vascular invasion. World J Surg, 2015, 39(6): 1485-1493.
2. Kim JM, Kwon CH, Joh JW, et al. Incidental microscopic bile duct tumor thrombi in hepatocellular carcinoma after curative hepatectomy: a matched study. Medicine (Baltimore), 2015, 94(6): e450.
3. Orimo T, Kamiyama T, Yokoo H, et al. Hepatectomy for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus, Including Cases with Obstructive Jaundice. Ann Surg Oncol, 2016, 23(8): 2627-2634.
4. An J, Lee KS, Kim KM, et al. Clinical features and outcomes of patients with hepatocellular carcinoma complicated with bile duct invasion. Clin Mol Hepatol, 2017, 23(2): 160-169.
5. Moon DB, Hwang S, Wang HJ, et al. Surgical outcomes of hepatocellular carcinoma with bile duct tumor thrombus: a Korean multicenter study. World J Surg, 2013, 37(2): 443-451.
6. Pang YB, Zhong JH, Luo XL, et al. Clinicopathological characteristics and liver stem cell marker expression in hepatocellular carcinoma involving bile duct tumor thrombi. Tumour Biol, 2016, 37(5): 5879-5884.
7. Navadgi S, Chang CC, Bartlett A, et al. Systematic review and meta-analysis of outcomes after liver resection in patients with hepatocellular carcinoma (HCC) with and without bile duct thrombus. HPB (Oxford), 2016, 18(4): 312-316.
8. Yamamoto S, Hasegawa K, Inoue Y, et al. Bile duct preserving surgery for hepatocellular carcinoma with bile duct tumor thrombus. Ann Surg, 2015, 261(5): e123-e125.
9. Rammohan A, Sathyanesan J, Rajendran K, et al. Bile duct thrombi in hepatocellular carcinoma: is aggressive surgery worthwhile? HPB (Oxford), 2015, 17(6): 508-513.
10. Jang YR, Lee KW, Kim H, et al. Bile duct invasion can be an independent prognostic factor in early stage hepatocellular carcinoma. Korean J Hepatobiliary Pancreat Surg, 2015, 19(4): 167-172.
11. Wang H, Yang J, Yang J, et al. Development and validation of a prediction score for complications after hepatectomy in hepatitis B-related hepatocellular carcinoma patients. PLoS One, 2014, 9(8): e105114.
12. Oba A, Takahashi S, Kato Y, et al. Usefulness of resection for hepatocellular carcinoma with macroscopic bile duct tumor thrombus. Anticancer Res, 2014, 34(8): 4367-4372.
13. 彭民浩, 杨定华. 原发性肝癌伴胆管癌栓致梗阻性黄疸(附 8 例报告). 中国普外基础与临床杂志, 1998, 5(2): 111-112.
14. 王磊, 周亚男, 张越, 等. 肝癌胆总管癌栓致阻塞性黄疸 17 例报告. 中国普外基础与临床杂志, 2006, 13(4): 444.
15. Espinosa JA, Merlo A Jr, Arafeh MO, et al. An unusual case of jaundice: Biliary tumor thrombus in fibrolamellar hepatocellular carcinoma. Int J Surg Case Rep, 2017, 36: 50-54.
16. Koh YX, Lee SY, Chok AY, et al. Icteric Intraductal Hepatocellular Carcinoma and Bile Duct Thrombus Masquerading as Hilar Cholangiocarcinoma. Ann Acad Med Singapore, 2016, 45(3): 113-116.
17. Zeng H, Xu LB, Wen JM, et al. Hepatocellular carcinoma with bile duct tumor thrombus: a clinicopathological analysis of factors predictive of recurrence and outcome after surgery. Medicine (Baltimore), 2015, 94(1): e364.
18. Tsuchikawa T, Hirano S, Okamura K, et al. Advances in the surgical treatment of hilar cholangiocarcinoma. Expert Rev Gastroenterol Hepatol, 2015, 9(3): 369-374.
19. Forsmark CE, Diniz AL, Zhu AX. Consensus conference on hilar cholangiocarcinoma. HPB (Oxford), 2015, 17(8): 666-668.
20. Bhardwaj N, Garcea G, Dennison AR, et al. The Surgical Management of Klatskin Tumours: Has Anything Changed in the Last Decade? World J Surg, 2015, 39(11): 2748-2756.
21. Wong TC, Cheung TT, Chok KS, et al. Outcomes of hepatectomy for hepatocellular carcinoma with bile duct tumour thrombus. HPB (Oxford), 2015, 17(5): 401-408.
22. Meng KW, Dong M, Zhang WG, et al. Clinical characteristics and surgical prognosis of hepatocellular carcinoma with bile duct invasion. Gastroenterol Res Pract, 2014, 2014: 604971.
23. Yu XH, Xu LB, Liu C, et al. Clinicopathological characteristics of 20 cases of hepatocellular carcinoma with bile duct tumor thrombi. Dig Dis Sci, 2011, 56(1): 252-259.
24. Shao W, Sui C, Liu Z, et al. Surgical outcome of hepatocellular carcinoma patients with biliary tumor thrombi. World J Surg Oncol, 2011, 9: 2.
25. Noda T, Nagano H, Tomimaru Y, et al. Prognosis of hepatocellular carcinoma with biliary tumor thrombi after liver surgery. Surgery, 2011, 149(3): 371-377.
26. Wang YD, Xue HZ, Jiang QF, et al. Surgical operation and re-operation for hepatocellular carcinoma with bile duct thrombosis. Chin Med J (Engl), 2010, 123(16): 2163-2170.
27. Ikenaga N, Chijiiwa K, Otani K, et al. Clinicopathologic characteristics of hepatocellular carcinoma with bile duct invasion. J Gastrointest Surg, 2009, 13(3): 492-497.