背景 肝门区胆管癌(Hilar cholangiocarcinoma, HC)是源于肝外左右肝管或左右肝管汇合处的胆道腺癌, 迄今对其治果不佳。本文通过相关文献回顾, 综述肝门胆管癌的治疗方法、治疗时机选择和术前检查评估。其中, 治愈性治疗包括局部切除、部分肝切除、联合尾状叶切除及肝门区淋巴结清扫、原位肝移植。局部切除仅适于局限于胆管壁及Bismuth I级乳头状癌;对HC大部分选择部分肝切除联合尾状叶切除及肝门区淋巴结清扫。这些术式可根据门静脉栓塞, 腹腔镜分期以及腹腔镜下超声等进行选择。但术前胆道引流存在争议;尽管Mayo指南中对无法切除的肝门胆管癌行原位肝移植的建议已被广泛接受, 但肝门胆管癌自体移植结果令人失望。缓解治疗方案包括分流手术, 内镜或经皮支架置入术, 光动力学治疗, 腔内短距离放射治疗, 外照射治疗以及系统性化疗。结论 恰当的R0切除是治疗的主要目标和选择, 对无法切除的肝门胆管癌病人, 治疗目标为改善生存质量。
Background Hilar cholangiocarcinoma (HC) originates in the main extrahepatic left or right duct or their confluence It’s still considered to be hard to treat or cure.Data source:We reviewed the medical literatures on HC and we analysis the relevant and updated information in a concise and easy-to-read manner.Result The selection and timing of management options for HC are determined by the diagnosis,the underlying liver function,the general condition of the patients and the stage of the disease.Nowadays,the treatment of HC can be divided into curative and palliative treatment.For the curative treatment,local excision should only be used on Bismuth I papillary carcinoma.Combined partial hepatectomy should be combined with caudate lobe resection and porta-hepatis lymph node dissection.The results of these surgical selections can be improved by portal vein embolization,staging laparoscopy and laparoscopic ultrasound.The role of preoperative biliary drainage is controversial.Autotransplantation for HC gave disappointing results while the Mayo Protocol of chemoradiation for selecting patients with unresectable HC for orthotopic liver transplantation has been widely accepted.Palliative treatment included bypass surgery,endoscopic or percutaneous stenting,photodynamic therapy,intraluminal brachytherapy,and external radiation and systemic therapy.Conclusions:Adequate surgery with R0 resection should be the main goal of treatment.For patients with unresectable HC,treatment aims to improve the quality and quantity of their survival.
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