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中华普外科手术学杂志(电子版) ›› 2024, Vol. 18 ›› Issue (05) : 589 -590. doi: 10.3877/cma.j.issn.1674-3946.2024.05.032

临床经验

一例罕见的肝内胆管癌合并胆管癌栓病例报告
孙涛1, 张茗2, 倪庆强1, 张士哲3, 刘方峰1, 卢俊1, 常宏1,()   
  1. 1. 250000 济南,山东第一医科大学附属省立医院肝胆外科;250024 济南,山东第一医科大学(山东省医学科学院)
    2. 250024 济南,山东第一医科大学(山东省医学科学院)
    3. 250000 济南,山东第一医科大学附属省立医院肝胆外科
  • 收稿日期:2023-09-03 出版日期:2024-10-26
  • 通信作者: 常宏
  • 基金资助:
    山东省2020年自然基金项目资助(ZR2020MH054)

A rare case report of intrahepatic cholangiocarcinoma with cholangiocarcinoma embolus

Tao Sun, Ming Zhang, Qingqiang Ni   

  • Received:2023-09-03 Published:2024-10-26
引用本文:

孙涛, 张茗, 倪庆强, 张士哲, 刘方峰, 卢俊, 常宏. 一例罕见的肝内胆管癌合并胆管癌栓病例报告[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 589-590.

Tao Sun, Ming Zhang, Qingqiang Ni. A rare case report of intrahepatic cholangiocarcinoma with cholangiocarcinoma embolus[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(05): 589-590.

原发性肝癌有两种主要类型—肝细胞癌(HCC)和肝内胆管癌(ICC),还有一类罕见的肝肉瘤。ICC是起源于胆管上皮细胞的恶性肿瘤,发病率约占原发性肝癌的10%,远远少于HCC约70%的发病率。尽管其发病率低,但发病率呈逐年上升趋势,其危险因素包括病毒感染导致的肝炎、肝硬化,肝内外胆管结石长期刺激引起的炎症,不良的生活方式(酗酒、抽烟等)以及胆汁淤积和寄生虫感染等危险因素。胆管癌栓(BDTT)作为肝癌的一种特殊病理状态,最早由Mallory等于1947年首次报道,1975年Lin根据黄疸的症状将BDTT命名为“黄疸型肝癌”。BDTT发生机制尚不明确,且手术方式存在较大争议,目前国际尚无统一分型与治疗指南。其中,HCC合并BDTT发病率就较为少见,仅占 HCC 的 1.2%~12.9%,相关的临床诊断、治疗的原则尚待进一步明确,而ICC合并BDTT则更为少见,现将临床工作中发现的1例ICC合并BDTT 报道如下。

图1 上腹部磁共振(MRI)、磁共振胰胆管成像(MRCP) 注:A=MR平扫(箭头所示):肿瘤位于Ⅳ、Ⅴ段交界处,可见团块状稍高密度影;B=MR强化(箭头所示):可见孤立癌栓;C=MRCP(箭头所示):癌栓位于肝总管,可见肝门区胆管T2WI高信号消失,充盈缺损,其上游胆系扩张。
图2 肿瘤与癌栓示意图
图3 术中癌栓位于肝总管(箭头所示) 图4 胆管癌栓大体观,质软、灰白
图5 术中快速冰冻病理结果 注:HE染色;A=(癌栓)胆管内癌栓,查见不典型增生;B=(肝肿物)胆管细胞癌的腺样成分,倾向为腺癌。
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