肝癌合併慢性第三型的膽道栓塞：肝膽代償機能減退呈現

Chronic Type III Biliary Duct Thrombi of Hepatocellular Carcinoma Mimics as Liver Decompensation

在全球肝癌合併第3型的膽道栓塞是非常少見，甚至在台灣這種肝癌高盛行率的國家亦是少見，發生率約是1.2 -9%。肝癌合併膽道栓塞是因為腫瘤侵犯到膽道系統而導致栓塞如腫瘤的碎塊或是良性血塊會進入膽道內，最後造成阻塞。第三型的膽道栓塞是指總膽管有游離的栓塞。當栓子阻塞在總膽管，黃疸會迅速竄升甚至發生膽管炎。我們將報告一個個案，七十四歲男性病人患有肝癌合併有第三型膽道栓塞， 臨床上進展卻是緩慢的，且以肝臟代償機能減退表現。

Hepatocellular carcinoma (HCC) with type III biliary duct thrombi (BDT) is rare in the world, even in Taiwan where the incidence of HCC is high. The incidence of HCC with BDT is 1.2-9%. This comorbidity suggests HCC involvementin the biliary tract and thrombi though the spread of cancer debris or the development of benign blood clots extending into biliary tract. Type III BDT is term referring to free thrombi in CBD. In this case, common bile duct (CBD) will be dilated when it is obstructed by thrombi and when bilirubin levelsrapidly elevate with or without cholangitis. Herein we report a case of 74-year-old gentleman with HCC chronic type III BDT mimicking chronic liver decompensation.