胆管内乳头状肿瘤的诊治策略  

Diagnosis and treatment strategies for intraductal papillary neoplasm of the bile duct

作　　者：王浩年 孙备[1] 陈华[1] Haonian Wang;Bei Sun;Hua Chen(Department of Pancreatic and Biliary Surgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院胰胆外科,150001

出　　处：《中华肝脏外科手术学电子杂志》2024年第2期140-144,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：黑龙江省普通本科高等学校青年创新人才培养计划(UNPYSCT-2016187)。

摘　　要：胆管内乳头状肿瘤(IPNB)是一种少见的胆系肿瘤,其特征为导管内肿瘤乳头状增生,伴有胆道系统扩张,及可能出现的导管内黏液分泌。IPNB的临床表现缺乏特异性,根据肿瘤不同的生长部位及发展程度可表现为腹痛及梗阻性黄疸,部分合并胆道感染患者可出现发热、寒战等急性胆管炎症状。血液化验可有肝功能异常、胆红素升高等改变。影像学检查包括腹部超声、平扫或增强CT、MRI、内镜超声等。现有影像学诊断方法尚无法在术前对IPNB进行高特异性的有效鉴别诊断。治疗方式目前推荐以手术切除作为首选。具体术式选择包括胰十二指肠切除术、胆总管切除胆肠吻合术、肝门胆管癌根治术联合肝脏部分切除术等。目前尚无明确证据证明手术切除后辅助放化疗的必要性。Intraductal papillary neoplasm of the bile duct(IPNB)is a rare biliary neoplasm,which is characterized by intraductal papillary hyperplasia,complicated with biliary ductal system dilatation and possible intraductal mucus secretion.Clinical manifestations of IPNB are non-specific.According to different growth sites and grades of the neoplasm,it can be manifested as abdominal pain and obstructive jaundice.Patients complicated with biliary tract infection develop symptoms of acute cholangitis,such as fever and chills,etc.Blood test may indicate abnormal liver function and elevated bilirubin levels.Imaging examinations consist of abdominal ultrasound,plain or enhanced CT,MRI and endoscopic ultrasound,etc.Current imaging tools fail to make a highly-specific and effective differential diagnosis of IPNB before operation.At present,surgical resection is recommended as the optimal treatment.Surgical approaches include pancreaticoduodenectomy,choledochotomy+cholangiojejunostomy,radical resection of hilar cholangiocarcinoma+partial hepatectomy,etc.There is no definite evidence to prove the necessity of adjuvant chemoradiotherapy after surgical resection.

关 键 词：胆管内乳头状肿瘤 癌前病变 粘蛋白分泌 分子机制 

分 类 号：R735.8[医药卫生—肿瘤]