Zhou Di, Zhang Bo, Zhang Xiao-Yu, Guan Wen-Bin, Wang Jian-Dong, Ma Fei
Department of General Surgery, Xinhua Hospital Affiliated with Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China.
Department of General Surgery, Xinhua Hospital Affiliated with Shanghai Jiao Tong University, School of Medicine, Chongming Branch, Shanghai 202150, China.
World J Clin Cases. 2020 Dec 6;8(23):5902-5917. doi: 10.12998/wjcc.v8.i23.5902.
Focal intrahepatic strictures (FIHS) refer to local strictures of the small and medium intrahepatic bile ducts. FIHS are easily misdiagnosed due to their rare incidence, and few studies have focused on the diagnosis and treatment approaches.
To propose a new classification for FIHS in order to guide its diagnosis and treatment.
The symptoms, biochemistry results, imaging results, endoscopic examination results and initial and final diagnoses of 6 patients with FIHS admitted between January 2010 and December 2019 were retrospectively analyzed.
The 6 patients were diagnosed with intratubular growth-type intrahepatic cholangiocarcinoma (IG-ICC), recurrent multiple hepatocellular carcinoma (rmHCC) with bile duct tumor thrombus (BDTT), adenosquamous carcinoma (ASC), hepatolithiasis, small duct primary sclerosing cholangitis (SD-PSC) and autoimmune hepatitis (AIH). The initial and final diagnoses were not consistent in 4 patients. Hepatectomy was performed in patients with IG-ICC, ASC and hepatolithiasis according to the locations of their FIHS. Patients with rmHCC with BDTT received lenvatinib/sintilimab, while patients with SD-PSC and AIH received UDCA. We proposed the following classification system for FIHS: type I: FIHS located within one segment of the liver; type II: FIHS located at the confluence of the bile ducts of one segment or two adjacent segments; type III: FIHS connected to the left or right hepatic duct; and type IV: Multiple FIHS located in both lobes of the liver.
Our proposed classification system might help to guide the diagnosis and treatment of FIHS. Hepatectomy should be performed not only for malignant FIHS but also for benign strictures with severe secondary damage that cannot be improved by nonsurgical methods.
肝内局灶性狭窄（FIHS）是指肝内中小胆管的局部狭窄。由于其发病率低，FIHS容易被误诊，且很少有研究关注其诊断和治疗方法。
提出一种新的FIHS分类方法，以指导其诊断和治疗。
回顾性分析2010年1月至2019年12月收治的6例FIHS患者的症状、生化结果、影像学结果、内镜检查结果以及初始和最终诊断。
6例患者分别诊断为管内生长型肝内胆管癌（IG-ICC）、复发性多发性肝细胞癌（rmHCC）伴胆管癌栓（BDTT）、腺鳞癌（ASC）、肝内胆管结石、小胆管原发性硬化性胆管炎（SD-PSC）和自身免疫性肝炎（AIH）。4例患者的初始和最终诊断不一致。IG-ICC、ASC和肝内胆管结石患者根据其FIHS的位置进行了肝切除术。rmHCC伴BDTT患者接受了乐伐替尼/信迪利单抗治疗，而SD-PSC和AIH患者接受了熊去氧胆酸治疗。我们提出了以下FIHS分类系统：I型：FIHS位于肝脏的一个肝段内；II型：FIHS位于一个肝段或两个相邻肝段胆管的汇合处；III型：FIHS与左或右肝管相连；IV型：多个FIHS位于肝脏的两叶。
我们提出的分类系统可能有助于指导FIHS的诊断和治疗。肝切除术不仅应适用于恶性FIHS，也适用于非手术方法无法改善的具有严重继发性损害的良性狭窄。
