Hajer Jan, Havlůj Lukáš, Whitley Adam, Oliverius Martin, Gürlich Robert
Cas Lek Cesk. 2019 Spring;158(2):68-72.
Cholangiocarcinoma is a relatively rare, highly fatal neoplasm originating from the biliary epithelium. Its only potentially curative treatment option is a radical surgical resection. The aim of our work was to evaluate the feasibility and the safety of intraoperative ERCP and direct cholangioscopy (SpyGlass) to assess the intraductal border of cholangiocarcinoma proliferation. The study ran from November 2015 to January 2018. The group included patients with histologically verified cholangiocarcinoma and, based on available examinations, the resectability of the tumor was assessed by a multidisciplinary team. In cases of indicated surgical resection we peroperatively performed ERCP with cholangioscopy SpyGlass and "diaphanoscopy" in all patients. The resectability was assessed on the basis of these examinations and the peroperative surgical findings. The resection procedure itself was performed only in 2 out of the total of 14 patients, as other patients were indicated for the implantation of metallic SEMS within the ERCP procedure in the operating room instead. To validate the cholangioscopic findings, we used our own criteria based on both the Monaco and other criteria. We divided the findings according to the presence or absence of ulceration, prominent polyposis, pathological vascularization (4 types), pressure defect with a coagulum in the presence of previous stent implantation, papillomatous changes or discolorations of the mucosa. Out of the total number of 14 patients only two patients were indicated for resection and in both cases R0 resection was achieved. The remaining patients were intraoperatively indicated for palliative implantation of SEMS based on the same unresectable finding during cholangioscopy and laparotomy. We demonstrated the technical feasibility and safety of direct peroperative cholangioscopy. Our results show that direct perioperative cholangioscopy is one of the methods which can contribute to a more accurate determination of tumor spread margins.
胆管癌是一种相对罕见、致死率很高的起源于胆管上皮的肿瘤。其唯一可能治愈的治疗选择是根治性手术切除。我们这项研究的目的是评估术中内镜逆行胰胆管造影术（ERCP）和直接胆管镜检查（SpyGlass）来评估胆管癌增殖的导管内边界的可行性和安全性。该研究从2015年11月持续至2018年1月。研究组纳入了经组织学证实为胆管癌的患者，并基于现有检查，由多学科团队评估肿瘤的可切除性。在指示进行手术切除的病例中，我们在所有患者术中均进行了带有SpyGlass胆管镜的ERCP及“透照检查”。根据这些检查结果及术中手术发现评估可切除性。在总共14例患者中，只有2例进行了切除手术，因为其他患者在手术室的ERCP操作过程中被指示植入金属自膨式金属支架。为验证胆管镜检查结果，我们基于摩纳哥标准及其他标准制定了自己的标准。我们根据是否存在溃疡、显著息肉样变、病理性血管形成（4种类型）、在先前有支架植入情况下伴有凝块的压迹缺损、乳头状改变或黏膜变色对检查结果进行分类。在14例患者中，仅有2例被指示进行切除手术，且两例均实现了R0切除。其余患者基于胆管镜检查及剖腹手术中相同的不可切除发现，术中被指示进行SEMS姑息性植入。我们证明了术中直接胆管镜检查的技术可行性和安全性。我们的结果表明，术中直接胆管镜检查是有助于更准确确定肿瘤扩散边界的方法之一。
