周围神经侵犯对胆囊癌外科治疗的不利影响和对策  

Adverse effects of perineural invasion on surgical treatment of gallbladder cancer and diagnostic and therapeutic countermeasures

作　　者：李斌 LI Bin(Department of Biliary TractⅠ,the Third Affiliated Hospital of Naval Medical University(Shanghai Eastern Hepatobiliary Surgery Hospital),Shanghai 200438,China)

机构地区：[1]海军军医大学第三附属医院(上海东方肝胆外科医院)胆道一科,上海200438

出　　处：《中国实用外科杂志》2025年第2期168-173,共6页Chinese Journal of Practical Surgery

基　　金：上海市科委“科技支撑计划”西医引导类项目(No.19411967000);上海市科委“科技创新行动计划”医学创新研究专项(No.24Y12800504)。

摘　　要：外科治疗是胆囊癌最有效的治疗手段,但进展期胆囊癌术后肿瘤复发率高、预后较差。周围神经侵犯是胆囊癌侵袭发展早期的关键性事件,也是影响进展期胆囊癌外科治疗结局的重要不利因素。提高术前周围神经侵犯诊断的准确性以制订、实施个体化手术方案,实现癌细胞隐匿残留风险区域清扫的彻底性,以及术后辅助性放、化疗等多模式治疗策略,对降低与周围神经侵犯相关的肿瘤复发风险、整体提升进展期胆囊癌外科治疗效果具有重要意义。基于周围神经侵犯生物标记物、高场强MRI解剖或功能或代谢多模态数据、影像组学数据以及人工智能技术等建立智慧诊断模型,以及开展基于术中荧光示踪的合理肿瘤切除及区域清扫范围和围手术期放疗联合靶向或免疫治疗等临床研究,将为构建进展期胆囊癌个体化多模式诊治方案提供证据。Surgical treatment is the most effective treatment for gallbladder cancer(GBC),but advanced GBC has a high rate of tumor recurrence and poor prognosis after surgery.Perineural invasion(PNI) is a critical event in the early stages of invasive GBC progression and an important unfavorable factor affecting the outcome of surgical treatment for advanced GBC.Improving the accuracy of preoperative diagnosis of PNI to formulate and implement individualized surgical plans,achieving the thoroughness of clearing the risk area of hidden residual cancer cells,and adopting postoperative multimodal treatment strategies such as adjuvant radiotherapy and chemotherapy are of great significance in reducing the risk of tumor recurrence associated with PNI and improving the overall outcome of surgical treatment for advanced GBC.The establishment of intelligent diagnostic models based on PNI biomarkers,multimodal data(including anatomic,functional and metabolic data) from high-field intensity MRI,radiomics data,and artificial intelligence technology,as well as the conduct of clinical studies(such as rational tumor resection and regional clearance scope based on intraoperative fluorescent tracing and perioperative radiotherapy combined with targeted or immunotherapy) will provide evidence for the construction of an individualized multi-modal diagnostic and treatment plan for advanced GBC.

关 键 词：胆囊癌 周围神经侵犯 多模式诊治 

分 类 号：R6[医药卫生—外科学]