探讨射频消融治疗原发性肝癌（肝癌）合并胆管癌栓的应用价值。

回顾性分析2009年12月至2014年12月在解放军总医院行射频消融治疗的14例肝癌合并胆管癌栓患者临床资料。其中男11例，女3例；年龄45～68岁，中位年龄54岁；均合并肝硬化。患者均签署知情同意书，符合医学伦理学规定。患者采用开腹超声引导下肿瘤射频消融，再行胆总管切开取癌栓，并对癌栓根部消融。观察患者围手术期情况、并发症发生情况及预后。

患者均顺利完成手术，术中出血量≤50 ml，术后住院时间8～34 d。术后并发症发生率71%（10/14），其中包括胸腔积液10例，腹腔积液加重8例，胆红素升高6例，肾功能异常3例，均经保肝、营养支持等治疗后好转。无围术期死亡。2例术后1个月复查发现肿瘤残余，予TACE治疗。随访期间死亡10例，生存时间9～22个月，中位生存时间17个月，1年存活率85%。

对于不能手术切除的肝癌合并胆管癌栓患者，射频消融安全、有效，能明显减少取癌栓过程中出血，是一种较理想的治疗方法。

To investigate the application value of radiofrequency ablation (RFA) for primary liver cancer complicated with bile duct tumor thrombus (BDTT).

Clinical data of 14 patients with primary liver cancer and BDTT undergoing RFA in Chinese PLA General Hospital between December 2009 and December 2014 were retrospectively analyzed. There were 11 males and 3 females, aged from 45 to 68 years old with a median age of 54 years old. All patients were complicated with liver cirrhosis. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients first underwent ultrasound-guided RFA through open surgery for the tumor, and then underwent choledochotomy + removal of BDTT, and finally ablation of the root of BDTT. Perioperative status, incidence of postoperative complications and clinical prognosis of the patients were observed.

All patients underwent surgery successfully. The intraoperative blood loss was ≤50 ml and the postoperative length of hospital stay ranged from 8 to 34 d. The incidence of postoperative complications was 71%(10/14), including 10 cases with pleural effusion, 8 with exacerbation of ascites, 6 with elevated bilirubin and 3 with renal dysfunction. All complications were alleviated after liver-protecting and nutrition supportive therapy. No death was observed during the perioperative period. At 1 months after surgery, residual tumor was found in 2 cases and they were treated with transcatheter arterial chemoembolization (TACE). Ten patients died during the follow-up. The survival time ranged from 9 to 22 months with a median of 17 months and the 1-year survival rate 85%.

RFA is a safe, effective and ideal treatment for patients with unresectable primary liver cancer and BDTT, and it can significantly reduce the intraoperative blood loss during BDTT removal.