胆道生态系统:全局视角下的胆道外科关键科学问题  

The biliary ecosystem:a holistic perspective on critical scientific issues regarding biliary tract surgeries and diseases

作　　者：王向 付静 Wang Xiang;Fu Jing(Second Department of Biliary Surgery,the Third Affiliated Hospital of Naval Medical University,Shanghai200438,China;National Center for Liver Cancer,Naval Medical University,Shanghai201823,China)

机构地区：[1]海军军医大学第三附属医院胆道二科,上海200438 [2]海军军医大学国家肝癌科学中心,上海201823

出　　处：《中华外科杂志》2025年第1期39-44,共6页Chinese Journal of Surgery

基　　金：国家自然科学基金(82203209、82073411);国家重点研发计划(2022YFC3400902);中国博士后科学基金(面上项目)(2022M720786)。

摘　　要：随着胆道外科现代诊疗体系的建立与科学研究范式的转变,无论是良性还是恶性胆道疾病,均已进入精准化、个体化、全程化及多学科协作的诊疗和研究阶段。然而胆道外科医师仍面临着两大困境:(1)外科技术在降低良性胆道疾病致残率、提高胆道肿瘤患者生存率方面进入了瓶颈期;(2)对于“切胆保胆”“如何减黄”等临床争议,传统的临床研究似乎难以给出确切答案。借鉴系统生物学的理念,作者提出了“胆道生态系统”的概念框架:胆管是丛林,血管、淋巴管、神经和免疫系统是土壤,干细胞是种子,胆汁是河流,肝细胞是河流的发源地。良恶性疾病具有动态转化的特征;不同部位的胆管构成“大”环境,胆汁形成“小”环境,不同细胞组成“微”环境;细胞亚群具有不同状态及多样性,并受复杂分子信号网络的调控。作者据此进一步凝练了胆道外科的若干关键科学问题,提出了优化研究范式的建议,旨在从全局视角推动学科交叉融合,推动胆道外科临床及转化研究。The establishment of modern biliary surgery system,alongside pivotal scientific paradigm shifts,has heralded a new era featured by precision,personalization,life-cycle care,and multidisciplinary management in the treatment of both benign and malignant biliary diseases.However,two formidable challenges persist in haunting the treatment of biliary diseases:(1)The refinement of surgical techniques has reached a plateau in reducing the disability associated with benign biliary conditions and in improving survival outcomes in biliary tract cancers;(2)Traditional evidence-based clinical studies have shown limited power in addressing complex dilemmas,such as determining whether to excise or preserve pathological gallbladders or selecting the optimal biliary drainage strategy.Consequently,the authors propose the conceptual framework of“biliary ecosystem”.In this model,diverse and abundant cholangiocytes represent forest,while blood vessels,nerves,and lymphatic vessels serve as nurturing soil,biliary stem cells function as seeds,bile flows like river network,and hepatocytes mark the river′s origins.Both benign and malignant biliary diseases exhibit significant spatiotemporal dynamics.The bile ducts form the“macro”environment,bile constitutes the“sub-macro”environment,and diverse cellular niches create the microenvironment.Specific pathological biliary conditions are shaped by intricate regulatory mechanisms that operate across these three tiers.Within the biliary ecosystem,cellular subpopulations exist remarkable diversity with states of homeostasis,oscillation,perturbation,or imbalance,underpinned by complex signaling networks.This holistic approach allows us to reframe and critically examine the pressing scientific issues confronting biliary tract diseases.Based on this framework,the authors distill key scientific questions and offer preliminary recommendations for embracing the paradigm shift.The authors anticipate that this conceptual model will promote interdisciplinary integration and accelerate clinic

关 键 词：胆道疾病 胆道肿瘤 胆道生态系统 普通外科学 范式转变 多组学技术 

分 类 号：R657.4[医药卫生—外科学]