晚期局部肝门部胆管癌应用新辅助治疗进行术前降期的研究现状  

Current status of preoperative downstaging of advanced local hilar cholangiocarcinoma with neoadjuvant therapy

作　　者：环韵峰 刘立鑫[1] 张小文[1] Huan Yunfeng;Liu Lixin;Zhang Xiaowen(Department of Hepatobiliary Surgery,Second Affiliated Hospital,Kunming Medical University,Yunnan Kunming 650033,China)

机构地区：[1]昆明医科大学第二附属医院肝胆外科,云南昆明650033

出　　处：《腹部外科》2022年第6期452-456,F0004,共6页Journal of Abdominal Surgery

基　　金：国家自然科学基金(81760403)。

摘　　要：对可切除的肝门部胆管癌首选根治性手术切除,而晚期局部不可切除的肝门部胆管癌可在新辅助治疗降期后再行肝移植或根治性切除,相比姑息性治疗,明显提高了病人的生存时间。但目前对晚期局部不可切除的肝门部胆管癌的界限目前还没有达成共识。新辅助放化疗后行肝移植有相对明确的入组标准,移植后的病人生存率相比根治性切除有显著的提高,放化疗的方案也趋于统一。而新辅助放化疗后的肝切除在病人的入组选择和放化疗方案方面各中心都有较大差别;可以确定的是晚期局部不可切除的肝门部胆管癌新辅助治疗后可以提高R0切除率,但是否可以改善病人预后还有争议。光动力治疗因其3种相互协助的抗肿瘤机制、超高的局部反应率高和较低的副作用,体现出一定的治疗优势,特别是随着新一代的光敏剂的应用,其治疗前景未来可期。靶向及免疫治疗使胆管癌的治疗迈向精准化,但新辅助靶向及免疫治疗肝门部胆管癌还缺乏研究证据。此文就晚期局部不可切除的肝门部胆管癌的新辅助治疗研究现状做一论述。Radical resection has been a first choice for resectable hilar cholangiocarcinoma.For advanced locally unresectable hilar cholangiocarcinoma,liver transplantation or radical resection may be performed after neoadjuvant therapy downstaging.Compared with palliative treatment,survival time significantly improves.However,resectable boundary of advanced locally unresectable hilar cholangiocarcinoma is currently hotly debated.Relatively definite criteria are available for liver transplantation after neoadjuvant chemoradiotherapy.The survival rate of patients after transplantation is significantly higher than that of radical resection and the regimens of neoadjuvant chemoradiotherapy are generally standardized However,hepatectomy after neoadjuvant chemoradiotherapy differs greatly patient enrollment and regimens of chemoradiotherapy.R0 resection rate is enhanced after neoadjuvant therapy for advanced locally unresectable hilar cholangiocarcinoma.But it remains controversial whether or not it can improve patient prognosis.Photodynamic therapy offers some therapeutic advantages because of its three mutually synergistic anti-tumor mechanisms,ultra-high local response rate and low side effects.Recent application of a new generation of photosensitizers is rather promising.The treatment of cholangiocarcinoma becomes more and more precise because of targeted therapy and immunotherapy.However,convincing proof is still lacking about neoadjuvant targeted and immunotherapy of hilar cholangiocarcinoma.This review summarized the latest progress of neoadjuvant therapy for advanced locally unresectable hilar cholangiocarcinoma.

关 键 词：肝门部胆管癌 新辅助放化疗 光动力治疗 靶向免疫治疗 肝移植 根治性切除 

分 类 号：R735.7[医药卫生—肿瘤]