探讨肝细胞癌（肝癌）胆管癌栓的病理特点及其对手术治疗预后的影响。

回顾性分析2007年6月至2012年6月在中山大学孙逸仙纪念医院肝胆胰外科行肝切除术的26例肝癌合并胆管癌栓患者临床资料。其中男23例，女3例；年龄23～78岁，中位年龄52岁。所有患者均签署知情同意书，符合医学伦理学规定。手术方式：行规则性肝切除术12例，不规则性肝切除术14例。对胆管癌栓处理方式：行胆管切开取栓术13例，肝外胆管切除术8例，胆管癌栓联合肿瘤一并切除5例。观察胆管癌栓的病理学特点，并分析其与肿瘤复发的关系。率的比较采用Fisher确切概率法。

单纯镜下小胆管癌栓2例，肉眼大胆管癌栓24例（合并单纯镜下小胆管癌栓14例）。24例肉眼大胆管癌栓中，Satoh's胆管癌栓临床分型Ⅰ型3例，Ⅱ型21例。26例胆管癌栓中，沿胆管壁上皮下蔓延扩散23例，见于绝大多数镜下小胆管癌栓和肉眼大胆管癌栓。胆管腔内蔓延扩散较少见，主要见于肉眼大胆管癌栓末端。随访期间肝内肿瘤复发10例，其中合并胆管癌栓复发8例。规则性肝切除术后肝内肿瘤复发率为3/9，不规则性肝切除术后肝内肿瘤复发率为58%（7/12）。13例行胆管切开取栓术患者中，7例术后胆管癌栓复发，复发率为54%（7/13）；8例行肝外胆管切除患者中，1例术后胆管癌栓复发,复发率为1/8，差异有统计学意义（P<0.05）。

肝癌胆管癌栓包括肉眼大胆管癌栓和镜下小胆管癌栓，癌栓蔓延的主要方式为沿胆管壁上皮下蔓延，规则性肝切除联合肝外胆管切除有可能减少肿瘤复发率和改善患者预后。

To investigate the pathological characteristics of bile duct tumor thrombi (BDTT) and its influence on the prognosis of patients with hepatocellular carcinoma (HCC) after surgical treatments.

Clinical data of 26 patients with HCC and BDTT (23 males, 3 females, age ranging from 23 to 78 years old and the median age of 52 years old) who underwent hepatectomy in Department of Hepatopancreatobiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from June 2007 to June 2012 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. The surgical procedures included regular hepatectomy (n=12), irregular hepatectomy (n=14). The treatments for BDTT included bile duct thrombectomy (n=13), extrahepatic bile duct resection (n=8), combined resection of BDTT and tumor (n=5). The pathological characteristics of BDTT were observed and its correlation with tumor recurrence was analyzed. The comparison of rates was conducted by Fisher's exact probability test.

Two cases of pure small microscopic BDTT and 24 cases of big macroscopic BDTT (14 cases were combined with pure small microscopic BDTT) were observed. According to the Satoh's BDTT clinical classification, there were 3 cases of typeⅠ, and 21 cases of type Ⅱ in 24 cases of big macroscopic BDTT. In all 26 cases of BDTT, sub-epithelium spreading along the bile duct wall was observed in 23 cases, most of which were small microscopic BDTT or big macroscopic BDTT. Intraductal spreading was rare and was observed mostly at the end part of big macroscopic BDTT. During the follow-up, intrahepatic tumor recurrence was observed in 10 cases, in which 8 cases were combined with BDTT recurrence. The intrahepatic tumor recurrence rate was 3/9 in patients after regular hepatectomy, and was 58% (7/12) in patients after irregular hepatectomy. In the 13 cases receiving bile duct thrombectomy, 7 cases suffered from BDTT recurrence with the recurrence rate of 54% (7/13). In the 8 cases receiving extrahepatic bile duct resection, 1 case suffered from BDTT recurrence with the recurrence rate of 1/8, where significant difference was observed (P<0.05).

BDTT of HCC includes macroscopic BDTT and microscopic BDTT. BDTT spreads mostly in sub-epithelium along the bile duct wall. Tumor recurrence rate may be reduced and the outcome may be improved by surgical treatments of regular hepatectomy combined with extrahepatic bile duct resection.