Gong B, Pan YM, Shen L, Hu B, Wu P, Wang SZ, Zhou DY. ERCP characteristics of 164 patients of hepatocellular carcinoma with obstructive jaundice.
Shijie Huaren Xiaohua Zazhi 2003;
11:1686-1689. [DOI:
10.11569/wcjd.v11.i11.1686]
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Abstract
AIM
To study the etiology and the manifestation of ERCP in patients of obstructive jaundice with HCC.
METHODS
Routine ERCP examinations were performed in 164 cases of hepatocellular carcinoma complicated with obstructive jaundice. Intrahepatic bile duct system was filled as much as possible. Biliary drainage and antibiotics were given routinely after the procedures.
RESULTS
Overall, 97.5% presented as malignant bile duct obstruction and 2.4% was benign biliary tract lesion. Among malignant obstruction, malignant hepatic hilar and perihilar bile duct stricture were found in 67.7%, intraductal tumor thrombus in 20.1%, intraductal thrombus with malignant perihilar stricture in 7.3%, metastasis of hilar lymph nodes in 1.8%, retroperitoneal lymph node metastasis in 1.2%. While in benign lesions, choledolithiasis and distal common bile duct stenosis were found in 1.2%, respectively. In 110 cases presented as malignant perihilar stricture, 95.4% were diagnosed as type III and IV. In 33 cases of ductal thrombi, 90.9% were classified as type III and IV. In 6 cases who were performed papillatomy to remove tumour thrombi, histopathologically, one was diagnosed possibly tumour, one of debris stone and necrotic tissues respectively, two of necrotic tumor tissues and 1 of HCC respectively. Two cases of bile duct cytology were shown exfoliated epithelial cells.
CONCLUSION
HCCs with obstructive jaundice are mostly caused by malignant stricture, particularly perihilar and hilar strictures. Next are tumour thrombi in biliary tract. Malignant perihilar stricture and tumour thrombi could be both existed in some patients. Jaundice caused by hilar and retroperitoneal lymph node metastasis is rare. Not all obstructive jaundice in HCC patients is malignant, a very small part could be caused by common bile duct stone and distal duct stenosis.
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