Buerlein Ross C D, Wang Andrew Y
Division of Gastroenterology and Hepatology, University of Virginia, PO Box 800708, Charlottesville, VA 22908, USA.
Division of Gastroenterology and Hepatology, University of Virginia, PO Box 800708, Charlottesville, VA 22908, USA.
Gastrointest Endosc Clin N Am. 2019 Apr;29(2):351-367. doi: 10.1016/j.giec.2018.11.006. Epub 2019 Feb 2.
Most patients with perihilar cholangiocarcinoma present with surgically unresectable disease owing to the insidious nature of this malignancy. Relief of malignant perihilar biliary obstruction is a key aspect of cholangiocarcinoma. Although palliative stenting using uncovered metal stents has been advocated in patients with unresectable malignant perihilar biliary strictures, several endoscopic retrograde cholangiopancreatography-guided ablative modalities have emerged. Palliative photodynamic therapy, radiofrequency ablation, and intraluminal brachytherapy have been associated with improved stent patency and survival, although the ideal treatment approach remains unclear. This article reviews the published evidence for using each of these endobiliary ablative modalities in this difficult-to-treat patient population.
大多数肝门部胆管癌患者由于这种恶性肿瘤的隐匿性而表现为手术无法切除的疾病。缓解恶性肝门部胆管梗阻是胆管癌的一个关键方面。尽管对于无法切除的恶性肝门部胆管狭窄患者，有人主张使用裸金属支架进行姑息性支架置入，但几种内镜逆行胰胆管造影引导下的消融方式已经出现。姑息性光动力疗法、射频消融和腔内近距离放射治疗与改善支架通畅率和生存率相关，尽管理想的治疗方法仍不明确。本文综述了在这一难以治疗的患者群体中使用这些胆管内消融方式的已发表证据。
