摘要
患者 男 50岁 恶心、呕吐伴黄疸半月。患者半月前无明显诱因出现恶心、
呕吐，呕吐为胃内容物，伴乏力、全身皮肤黄染，无发热、无寒战，无腹痛，在
武钢医院住院治疗，给予护肝治疗，症状未缓解，黄疸进行性加重，来我院，门
诊以“肝门部胆管癌”收入院。发病以来，患者精神差，食少，小便黄，大便正
常，体重明显减轻。既往有乙肝病史15年。PE：T37℃ R20次／分 P75次／分
BP130／80mmHg神志清晰，慢性病容，全身皮肤、巩膜黄染，淋表淋巴结无肿大。
心肺正常，腹壁无静脉曲张，右上腹压痛，无反跳痛，肝、脾肋下未及，Murphy’s
征(一)，肠鸣音正常。门诊CT提示：高位梗阻性黄疸，肝门部胆管癌。入院实
验室检查：血常规：正常，肝功能：ALT 336u／L。AST 244u/l．T-BILI 162.4umol／L
D-BILI 28．1 umol／L 总蛋白60．2G／L A／G 1．5 GGT 1113 u／L ALP 699u／L 肾
功能：正常，血清电解质正常，HBsAg(+)，血AFP 21400．53ug／L，心电图正常，
胸片正常，PT、APTT正常。B超提示：左门静脉栓塞，胆总管上段梗阻。三天后
在全麻下行剖腹探查术，术中见左肝外叶有一4．5×5．0cm的肿块，肝总管上端饱
满，左肝管有一直径2．5cm的瘤栓，遂行左肝叶切除+左肝管、门静脉瘤栓摘除术，
术中胆道镜见右肝管、胆总管下端均通畅，置T型管引流，术后诊断为原发性肝
癌，左肝管、胆总管、门静脉瘤栓形成，术后病检(左肝、门静脉、左肝管、胆
总管瘤栓)肝细胞性肝癌(II．III级)，术后给予抗炎、护肝治疗，患者恢复尚好，
半月后复查肝功能：ALT 104u／L AST 103u／L T-BILI 57．4 umol／L，ALB 32．2G／L
GGT、261u／L ALP 315u／L。随访一年后死于肝癌复发。
A man, 50 years old, has felt nause vomit and jaundice for half a month. Fifteen days ago, he felt nause vomit without any causing factors, the vomiting thing was content of stomach, and the same time he felt tired, his skin was jaundice, he felt no fever no chill no abdomen pain. He was accepted to hospital ward of WuGang Hospital, in ward, he was gave curing of protective liver, but the symptom wasn't alleviated, the jaundice was more and more graved, so he went to our hospital, and was accepted for "hilar cholangiocarcinoma". The man's vigour has been bad, he has ate very little food since he was ill, and his weight was lightened clearly. He has been hepatitis fifteen years.. PE: T37 R 20/min P 75/min BP 130/80mmHg Saint was clear, choice ill face, skin was jaundice, the swallow lymphnodes coundn't be felt. Heart and lung were normal. There were no veins bent in abdomen, he felt pain in up-right abdomen, and had press pain, no resist pain, his liver and spleen conndn't be felt under lib. CT sign: high obstructive jaundice, hilar cholangiocarcinoma. Lab-check:blood-Rt:Q liver-function:ALT 336u/L AST 244u/L TBILI 162.4umol/L D-BILI28.1 umol/L T-PROT 69.2G/L ALB41.8G/L A/G 1.5 GGT1113u/L ALP 699u/L kidney-function:Q HBsAg(+) blood-AFP 21400. 53 ug/L, heart electric Picture was normal, chest-x: normal. PT.APTT Q B-ultrosound sign:left portal vein thrombosis, up-choledochal obstructive. After three days, he was gave operation, we saw a 4.5 X 5.0cm pump in left leaf of left liver, a D-2.5cm thrombosis in left live tube, and thrombosis in choledochal and portal vein, he was gave left liver resection, and was picked out the thrombosis in left liver tube portal vein, there is nothing in right liver tube and down-choledochal, gave a T-tube. After surgery, he was diagnosised left liver carcinoma, left liver tube portal vein thrombosis. Pathology check(left liver portal vein left liver tube choledochal thrombosis) hepatocellocarcinoma( II-III). After surgery, he was gave cure of anti -infection, protect-liver, his recover was good, after
half a month his liver-function: ALT 104u/L AST 103u/L T-BILI 124.5umol/L D-BILI 57.4umol/L. ALB 32.2G/L GGT 261u/L ALP35lu/L, he was admitted to go home. He Survived one year..
引文
1. Tantawi B, cherqui D, Nhieu JIV, et al. Surgery for biliary obstruction by tumor thrombus in primary live cancer. Br J surg, 2002,83(1) 1522-1525
2. Qin LX, Tang ZY, Hepatocellular carcinoma with obstructive jaudice: diagnosis, treatment and prognosis. Wrld J Gastrotnterol, 2004 Mar: 9(3): 385-91
3. Lau WY, Leung JWC, Li Ake Management of hepatocellular carcinoma presenting as obstructive jaudice. Am J surg, 2002: 160:280.
4. Berdah SV, Delpero JR, Garcia S, et al. A westem surgical experience of peripheral cholangicarcinoma. Brit J surg, 2000; 160:280
5. Wang JH, Wang LY, Lin ZY, et al. Doppler Sonography of common hepatic duct tumor invasion in hepatocellular carcinoma: report of two cases. J Ultrasound Med,2003,14(6):471-474
6．韩立本，何震平，蔡景修等，肝细胞癌侵入胆道致梗阻恶黄疸的临床诊断，国外临床，1991，1：46
7. Wang JH, Chen TM, Tung HD, et al. Color Doppler sonography of bile duct tumor thrombi in hepatocellular carcinoma, J Uitra-sornd Med, 2002, Jul:21 (7):767-72
8. Zhao Q, Gong B, Lu N, et al. The endoscopil retrograde cholangiopancreatographic manifestations of histopathologically diagnosed hepatocellular carcinoma with obstructive jaundice. [J] Hua zhong univ scitechnology Med sci 2002;22(3):237-400
9. Buckmaster MJ, Schwartz RW, camahan, GE, et al. Hepatocellular carcinoma embolus to the common hepatic duct with no detectable primary hepatic tumor [J] Am surg, 2001,60(9):699-702
10. Tseng JH, Hurg CF, Ng KK, et al. Icteric-type hepstoma:magnetic resonance imaging and magnetic resonance cholangiographic features. Abdom Imaging 2001 Mar-Apr:26171-7
11. Wang HJ, Kim JH, Kimwit, et al. Hepatocellular carcinoma with tumor thrombi in the bile duct. Hepatogastroenterolgy, 2001 Jul-Aug; 46(28): 2495-9
12. Hu J;Pi Z; Yu MY: et al. Obstructive jaundice caused by tumor emboli from hepatocellular carcinoma. Am surg 2002 May; 65(6):406-10
13. Jan YY, Clen MF, Obstructive jaundice secondary to hepatocellular carcinoma rupture into the common bile duct choledochoscopic findings. Hepatogastroenterology 2001 Jan-Feb; 46(25)157-61
14. Nishio H, Miyata K, Hanai M, et al, Resection of an icteric type hepatoma with tumor thrombi filling the right Posterior bile duct, Hepatogastroenterology 2002 Nov-Dec 49(48): 1482-5
15. Lee JW, Han JK, Kim TK et al. Obstructive jaunldice in hepatocellular carcinoma: response after percutane ous transhepatic biliargy drainage and prognosic factors. Cardiovasc Inte veut Radiol 2002 May-JUN;25(3): 176-9
16. Okazaki M, Mizuta A, Hamada N et al. Hepatocellular carcinoma with obstructive jaundice successfully treated with a self-expandable metallic stent. J Gastroenterol 2003 Dec:33(6):886-90
17. Sung KF, Tsang NM; tseng JH et al. Effective relief of obstructive jaundic e in a patient with nonresectable icteric-type hepatocellular carcinoma by ezternal beam radiation therapy:case repert. Cheng Gung Med J 2001 Feb:24(2): 114-8.
