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KMID : 0371320050680030239
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Journal of the Korean Surgical Society
2005 Volume.68 No. 3 p.239 ~ p.243
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Hepatocellular Carcinoma with Biliary Tumor Thrombi
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주종우/Chu CW
김형철/임철완/신응진/조규석/류기원/이효원/송옥평/문종호/고은석/권계원/Kim HC/Lim CW/Shin WJ/Cho GS/Yu KW/Lee HW/Song OP/Moon JH/Koh ES/Kwon KW
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Abstract
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Hepatocellular carcinoma (HCC) with obstructive jaundice that is caused by bile duct tumor thrombi (BDT) is a rare finding and the appropriate treatment has not yet been detrmined. Some authors have reported that hepatic resection and the removal of the BDT without extrahepatic bile duct resection were sufficient procedures. On the other hand, other authors have reported that it was reasonable to resect the extrahepatic bile duct with the primary lesion. The 55- year-old man was admitted with obstructive jaundice and he was without any other symptoms. Preoperative ERCP (Endoscopic retrograde cholangiopancreatography) and CT (Computed tomography) showed the BDT extending from the main mass in the left lobe to the common hepatic duct. An ENBD (endoscopic naso-biliary drainage catheter) was placed to decrease the serum total bilirubin concentration (17.5 mg/dl on admission). The serum total bilirubin concentration was 4.7 mg/dl one day before the operation. The ICG-R15 was 36% one week before the operation. The serum AFP (alpha- fetoprotein) concentration was 4872 ng/ml. The serum ALP (alkaline phosphatase) and GGT (gamma-glutamyl transferase) concentrations were elevated. The serum albumin concentration and prothrombin time were normal. Left lobectomy, extrahepatic bile duct resection and Roux-en-Y hepaticojejunostomy were performed with stenting each bile duct orifice. Histologically, the BDT had partially invaded the confluence of the bile duct. At present, the patient is doing well without any recurrence of tumor. Many reports have insisted the BDT rarely invades the confluence portion of bile duct. Therefore BDT extraction without extrahepatic bile duct resection is a sufficient procedure for HCC with the BDT. However, this strategy was inadequate for our case.
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KEYWORD
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