Vogl T J, Zangos S, Eichler K, Gruber-Rouh T, Hammerstingl R M, Trojan J, Weisser P
Institut für Diagnostische und Interventionelle Radiologie, J.-W.-Goethe-Universität Frankfurt, Frankfurt.
Rofo. 2012 Oct;184(10):883-92. doi: 10.1055/s-0032-1312842. Epub 2012 Jun 18.
To present current data on diagnosis, indication and different therapy options in patients with cholangiocarcinoma (CC) based on an analysis of the current literature and clinical experience. The diagnostic routine includes laboratory investigations with parameters of cholestasis and also serum tumor markers CA19 - 9 and CEA. After ultrasound for clarifying a tumor and/or dilated bile ducts, contrast-enhanced magnetic resonance imaging (MRI) should be performed with magnetic resonance cholangiography (MRCP). The accuracy (positive predictive value) for diagnosing a CC is 37-84% (depending on the location) for ultrasound, 79-94% for computed tomography (CT), and 95% for MRI and MRCP. An endoscopic retrograde cholangiography (ERCP) can then be planned, especially if biliary drainage or cytological or histological specimen sampling is intended. A curative approach can be achieved by surgical resection, rarely by liver transplantation. However, many patients are not eligible for surgery. In addition to systemic chemotherapy, locoregional therapies such as transarterial chemoembolization (TACE), hepatic arterial infusion (HAI)--also known as chemoperfusion--, drug eluting beads-therapy (DEB) as well as thermoablative procedures, such as laser-induced thermotherapy (LITT), microwave ablation (MWA) and radiofrequency ablation (RFA) can be provided with a palliative intention.
基于对当前文献和临床经验的分析,呈现胆管癌(CC)患者诊断、适应证及不同治疗方案的现有数据。诊断流程包括进行胆汁淤积参数的实验室检查以及血清肿瘤标志物CA19-9和癌胚抗原(CEA)检测。在通过超声明确肿瘤和/或胆管扩张后,应进行对比增强磁共振成像(MRI)及磁共振胆胰管造影(MRCP)。超声诊断CC的准确性(阳性预测值)为37%-84%(取决于肿瘤位置),计算机断层扫描(CT)为79%-94%,MRI和MRCP为95%。然后可考虑进行内镜逆行胰胆管造影(ERCP),特别是在打算进行胆道引流或获取细胞学或组织学标本时。可通过手术切除实现根治性治疗,肝移植很少采用。然而,许多患者不符合手术条件。除全身化疗外,还可采用经动脉化疗栓塞(TACE)、肝动脉灌注(HAI,也称为化学灌注)、药物洗脱微球治疗(DEB)等局部区域治疗以及热消融手术,如激光诱导热疗(LITT)、微波消融(MWA)和射频消融(RFA),以达到姑息治疗目的。