弥漫型胆管癌临床病理学特征及外科治疗  

Clinicopathological features and surgical treatment of diffuse cholangiocarcinoma

作　　者：吴志勇[1] 

机构地区：[1]上海交通大学医学院附属仁济医院外科,上海200127

出　　处：《中国实用外科杂志》2016年第1期51-54,共4页Chinese Journal of Practical Surgery

摘　　要：胆管癌分为肝内、肝门、远端及弥漫型四种。弥漫型胆管癌是指肿瘤浸润较广泛或浸润全部肝外胆管,有两种类型,即浅表扩散性和弥漫浸润性。浅表扩散是指胆管癌从主瘤灶沿黏膜扩散>20 mm者,常见于胆管乳头状癌及其他分化好的腺癌中,恶性程度较低,预后较好。弥漫浸润是指胆管癌累及从肝门至远端的全部肝外胆管,病理学分期晚,预后差。应用MRI、多层螺旋CT以及胆管镜等检查,大多数病人可准确诊断胆管癌的大体类型及胆管累及的程度,特别是在浅表扩散性胆管癌中明确胆管黏膜累及的范围至关重要,这有助于设计精准的手术方案。弥漫型胆管癌需行包括大范围肝切除的肝胰十二指肠切除术者,术前大多需行胆道引流和门静脉栓塞,以增加手术的安全性及防止术后发生肝功能衰竭。Cholangiocarcinoma has been classified as intrahepatic, perihilar, distal and diffuse. Diffuse cholangiocarcinoma exhibits an extensive ductal spread invading from the hepatic hilus to the lower bile duct, which has two types, namely the superficial spreading and diffuse infiltrating type. Superficial spreading cholangiocarcinoma is defined as mucosal extension of more than 20mm from the main lesion, which is mostly observed in papillary carcinoma or other well differentiated adenocarcinomas of the bile duct. Superficial spreading cholangiocarcinoma is with low malignancy and comparatively good prognosis. Diffuse infiltrating cholangiocareinoma demonstrates that invading of the tumor involves whole extrahepatic bile duct, whose pathological staging is often late and the prognosis is poor. The gross type of cholangiocarcinoma and the invasive extent of tumor in most cases can be accurately evaluated by MRI, Multidetector Row CT （MDCT）and choledochoscope, etc. It＇s especially important to evaluate the extension of the mucosa in the superficial spreading cholangiocarcinoma, which will help the surgeons to design a precise surgery. Most of the patients suffered from diffuse cholangiocarcinoma need to undergo hepatopancreatoduodenectomy including major liver resection. To prevent from postoperative liver failure and improve surgical safety, it is necessary that the most patients receive biliary drainage and portal vein embolization before the operation.

关 键 词：胆管癌 浅表扩散 弥漫浸润 胆管乳头状癌 肝胰十二指肠切除术 

分 类 号：R6[医药卫生—外科学]