Rumalla A, Baron T H
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn., USA.
Dig Dis. 1999;17(4):194-200. doi: 10.1159/000016936.
Patients with a cholangiocarcinoma usually develop symptoms of biliary obstruction which dominate the course of their illness. At presentation, the diagnosis may be difficult to establish due to the desmoplastic nature of this tumor. Location and extent of the tumor, however, are more effectively evaluated by current radiologic techniques. Following these staging procedures, most patients are found to be unsuitable for curative resection. Therefore, establishing effective biliary drainage to relieve symptoms of obstruction becomes the most critical therapeutic goal in these patients. In the past, surgical biliary bypass procedures were advocated, but were associated with high perioperative morbidity and mortality rates. Endoscopic biliary stenting produces quick and effective relief of symptoms from biliary obstruction due to cholangiocarcinoma. Initially, successful biliary drainage is possible in most patients. However, subsequent stent occlusion or spread of tumor into nonstentable intrahepatic ducts leads to recurrent jaundice. Local therapies including (192)Ir brachytherapy and photodynamic therapy may prevent or postpone these problems.
胆管癌患者通常会出现胆道梗阻症状，这些症状在其病程中占主导地位。在就诊时，由于该肿瘤的促结缔组织增生特性，诊断可能难以确立。然而，目前的放射学技术能更有效地评估肿瘤的位置和范围。经过这些分期检查后，大多数患者被发现不适合进行根治性切除。因此，建立有效的胆道引流以缓解梗阻症状成为这些患者最关键的治疗目标。过去，提倡进行外科胆道旁路手术，但该手术与较高的围手术期发病率和死亡率相关。内镜下胆道支架置入术能迅速有效地缓解胆管癌所致胆道梗阻的症状。最初，大多数患者能够成功实现胆道引流。然而，随后支架闭塞或肿瘤扩散至无法置入支架的肝内胆管会导致黄疸复发。包括（192）铱近距离放射疗法和光动力疗法在内的局部治疗可能会预防或推迟这些问题。
