Anderson Blaire, Doyle M B Majella
Division of Transplantation Surgery, Department of Surgery, University of Nebraska Medical Center, 983285 Nebraska Medical Center, Omaha, NE 68198, USA.
Section of Abdominal Organ Transplant, Department of Surgery, Washington University School of Medicine, Washington University, 660 South Euclid Avenue, Campus Box 8109, St Louis, MO 63110, USA.
Surg Oncol Clin N Am. 2019 Oct;28(4):601-617. doi: 10.1016/j.soc.2019.06.003. Epub 2019 Aug 2.
Cholangiocarcinoma is an aggressive malignancy of the extrahepatic bile ducts. Hilar lesions are most common. Patients present with obstructive jaundice and intrahepatic bile duct dilation. Cross-sectional imaging reveals local, regional, and distant extent of disease, with direct cholangiography providing tissue for diagnosis. The consensus of a multidisciplinary committee dictates treatment. Resection of the extrahepatic bile duct and ipsilateral hepatic lobe with or without vascular resection and transplantation after neoadjuvant protocol are options for curative treatment. The goal of surgery is to remove the tumor with negative margins. Patients with inoperable tumors or metastatic disease are best served with palliative chemoradiotherapy.
胆管癌是肝外胆管的侵袭性恶性肿瘤。肝门部病变最为常见。患者表现为梗阻性黄疸和肝内胆管扩张。横断面成像可显示疾病的局部、区域和远处范围，直接胆管造影可为诊断提供组织。多学科委员会的共识决定治疗方案。新辅助治疗方案后切除肝外胆管和同侧肝叶，可选择或不进行血管切除及移植，这是根治性治疗的选择。手术的目标是切除切缘阴性的肿瘤。对于无法手术切除的肿瘤或转移性疾病患者，最佳治疗方法是姑息性放化疗。
