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病例资料 我院自1989年以来收治肝细胞癌126例,其中肝癌组织侵犯胆管导致梗阻性黄疸6例(占4.7%);男5例,女1例.年龄26～62岁.平均45.2岁.肝脏肿瘤及胆道癌栓均经手术及组织学检查确诊.临床上有肝癌与梗阻性黄疸的常见症状及体征.其中3例有反复发作畏寒、发热,并有上腹疼痛;3例病人有不同程度的肝肿大.实验室检查:6例患者血清总胆红素平均值为214±135μmol/L(正常值1.7～17.1μmol/L);直接/总胆红素≥65%者2例,≥70%者4例;AKP升高者4例;AFP≥400μg/L者4例;HBsAg阳性3例;丙氨酸转氨酶、γ-谷氨酸肽酶和乳酸脱氢酶均呈轻度至中度升高.影象学检查:本组B超检查6例CT扫描3例,ERCP检查1例.上述检查结果提示肝癌3例.6例均提示有高位或低位胆道梗阻,表现肝内外胆管扩张,2例胆管内示有高密度影,ERCP检查发现胆道内充盈缺损病灶1例.由此而误诊为高位胆管癌、胰头癌、胆石症各1例,无1例诊断肝癌合并胆道癌栓.
Case data Our hospital has treated 126 cases of hepatocellular carcinoma since 1989, including 6 cases of obstructive jaundice caused by invasion of hepatocellular carcinoma (4.7%); 5 males and 1 female, aged 26 to 62 years old, average 45.2 years old. Liver tumors and biliary tract tumor thrombi were confirmed by surgery and histological examination. Clinically, there were common symptoms and signs of liver cancer and obstructive jaundice. Among them, 3 cases had recurrent chills, fever, and epigastric pain; 3 patients had Different degrees of hepatomegaly. Laboratory tests: The average serum total bilirubin in 6 patients was 214±135 μmol/L (normal value 1.7 to 17.1 μmol/L); 2 patients had direct/total bilirubin ≥65%. ≥70% of 4 patients; AKP increased in 4 patients; AFP ≥400 μg/L in 4 patients; HBsAg positive in 3 patients; alanine aminotransferase, γ-glutamic acid peptidase and lactate dehydrogenase were mild To moderate increase. Imaging examination: B ultrasound examination of the group of 6 cases of CT scan in 3 cases, ERCP examination in 1 case. The above results suggest that 3 cases of liver cancer. 6 cases were prompted with high or low biliary obstruction, manifestation of liver and outside Bile duct dilatation, 2 cases showed high density in the bile duct, ERCP examination revealed a case of filling defects in the bile duct. This led to misdiagnosis of high bile duct cancer, pancreatic cancer, and 1 case of cholelithiasis. 1 was diagnosed with HCC biliary thrombus.