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胆管癌的放射学诊断与介入治疗

[Radiological diagnosis and intervention of cholangiocarcinomas (CC)].

作者信息

Vogl T J, Zangos S, Eichler K, Gruber-Rouh T, Hammerstingl R M, Trojan J, Weisser P

机构信息

Institut für Diagnostische und Interventionelle Radiologie, J.-W.-Goethe-Universität Frankfurt, Frankfurt.

出版信息

Rofo. 2012 Oct;184(10):883-92. doi: 10.1055/s-0032-1312842. Epub 2012 Jun 18.

DOI:10.1055/s-0032-1312842
PMID:22711249
Abstract

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.

摘要

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。

相似文献

1
[Radiological diagnosis and intervention of cholangiocarcinomas (CC)].胆管癌的放射学诊断与介入治疗
Rofo. 2012 Oct;184(10):883-92. doi: 10.1055/s-0032-1312842. Epub 2012 Jun 18.
2
Cholangiocarcinoma: risk factors, diagnosis and management.胆管癌:危险因素、诊断与治疗
Rom J Intern Med. 2004;42(1):41-58.
3
[Cholangiocarcinoma--bile ducts cancer].[胆管癌——胆管癌症]
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Diagnosis and surgical treatment of hepatic hilar cholangiocarcinoma.肝门部胆管癌的诊断与外科治疗
Hepatobiliary Pancreat Dis Int. 2007 Dec;6(6):631-5.
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Endoscopic retrograde cholangiopancreatography in the diagnosis and management of cholangiocarcinoma.经内镜逆行胰胆管造影术在胆管癌的诊断和治疗中的应用。
Clin Liver Dis. 2010 May;14(2):333-48. doi: 10.1016/j.cld.2010.03.011.
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A modern approach to malignant hilar biliary obstruction.恶性肝门部胆管梗阻的现代治疗方法。
Rev Gastroenterol Disord. 2003 Fall;3(4):187-201.
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Three-dimensional computed tomographic cholangiography as a novel diagnostic tool for evaluation of bile duct invasion of perihilar cholangiocarcinoma.三维计算机断层胆管造影术作为评估肝门部胆管癌胆管侵犯的新型诊断工具。
Hepatogastroenterology. 2013 Nov-Dec;60(128):1833-8.
8
[MRCP (magnetic resonance cholangiopancreatography)--an assessment of current status].[磁共振胰胆管造影术(MRCP)——现状评估]
Z Gastroenterol. 1998 Mar;36(3):215-24.
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Malignant perihilar biliary obstruction: magnetic resonance cholangiopancreatographic findings.恶性肝门部胆管梗阻:磁共振胰胆管造影表现
Am J Gastroenterol. 2000 Feb;95(2):432-40. doi: 10.1111/j.1572-0241.2000.01763.x.
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Preoperative assessment of cholangiocarcinoma: meeting the challenge.胆管癌的术前评估:应对挑战
J Gastroenterol Hepatol. 1999 Jul;14(7):615-7. doi: 10.1046/j.1440-1746.1999.01927.x.

引用本文的文献

1
[Radiologic diagnosis of the gallbladder and bile ducts - part 2 : Acute and chronic cholecystitis, primary sclerosing cholangitis (PSC), benign and malignant masses of the biliary system].[胆囊和胆管的放射学诊断 - 第2部分:急性和慢性胆囊炎、原发性硬化性胆管炎(PSC)、胆道系统的良性和恶性肿块]
Radiologe. 2018 Dec;58(12):1099-1114. doi: 10.1007/s00117-018-0463-8.
2
Locoregional Therapies of Cholangiocarcinoma.胆管癌的局部区域治疗
Visc Med. 2016 Dec;32(6):414-420. doi: 10.1159/000453010. Epub 2016 Dec 5.
3
Extensive Use of Interventional Therapies Improves Survival in Unresectable or Recurrent Intrahepatic Cholangiocarcinoma.
广泛应用介入治疗可提高不可切除或复发性肝内胆管癌患者的生存率。
Gastroenterol Res Pract. 2016;2016:8732521. doi: 10.1155/2016/8732521. Epub 2016 Feb 4.