Lanza Davide, Casty Adrian, Schlosser Stefan H
Department of Gastroenterology and Hepatology, Regional Hospital Oberargaau, Langenthal, Switzerland.
Lindenhof-Spital, Bern, Switzerland.
Gastrointest Tumors. 2022 Feb 2;9(1):12-18. doi: 10.1159/000522363. eCollection 2022 Mar.
Hilar cholangiocellular carcinoma (CCC) is a malignant neoplasm of epithelial origin occurring at the confluence of the right and left hepatic bile ducts. Typically, these tumors are small, poorly differentiated, exhibit aggressive biologic behavior with non-specific symptoms and tend to obstruct the intrahepatic bile ducts. Surgery is the only available curative option. Unfortunately, in less than half of the patients a complete resection is possible with poor survival rate in unresectable cases. In this report, we present the case of a 58-year-old woman with a history of unresectable hilar cholangiocarcinoma. Initially she was treated with intraductal dilatation of malignancy and placement of a plastic stent and chemotherapy (Gemcitabin® and Platinol®). Two years later she underwent a second-line chemotherapy with Gemcitabin® and Oxyplatin® because of tumor progression. Despite a second line chemotherapy and placement of an uncovered self-expandible metal stent (ucSEMS) that was extended later on by stent-in stent technique, there was tumor progression which led to a complex course with relapsing obstructive cholangiosepsis and cholestasis. Because of tumor ingrowth, endobiliary radiofrequency ablation of the malignant stenosis was performed in repeated sessions. This case illustrates that radiofrequency ablation of solitary malignant biliary obstruction is feasible, safe and allows an improvement of quality of life in non-operable patients.
肝门部胆管细胞癌（CCC）是一种起源于上皮的恶性肿瘤，发生于左右肝管汇合处。通常，这些肿瘤较小，分化差，表现出侵袭性生物学行为，症状不具特异性，且倾向于阻塞肝内胆管。手术是唯一可行的治愈性选择。不幸的是，不到一半的患者能够进行完整切除，不可切除病例的生存率较低。在本报告中，我们介绍了一名58岁患有不可切除肝门部胆管癌病史的女性病例。最初，她接受了恶性肿瘤的导管内扩张、塑料支架置入及化疗（吉西他滨和顺铂）。两年后，由于肿瘤进展，她接受了吉西他滨和奥沙利铂的二线化疗。尽管进行了二线化疗并置入了裸金属自膨式支架（ucSEMS），且后来通过支架套叠技术进行了扩展，但仍有肿瘤进展，导致病情复杂，反复出现梗阻性胆管败血症和胆汁淤积。由于肿瘤向内生长，多次对恶性狭窄进行了胆管内射频消融。该病例表明，对孤立性恶性胆管梗阻进行射频消融是可行、安全的，并且可以改善无法手术患者的生活质量。
