Marcos-Alvarez A, Jenkins R L
Department of Hepatobiliary Surgery and Liver Transplantation, New England Deaconess Hospital, Boston, Massachusetts, USA.
Surg Oncol Clin N Am. 1996 Apr;5(2):301-16.
Resection is indisputably associated with prolongation of survival in patients with cholangiocarcinoma and provides the only chance for cure. Equally as important is the ability to achieve microscopically clean margins at the time of resection. Liberal use of hepatic resection in conjunction with hilar vascular skeletonization may improve the ability to achieve disease-free margins and can be performed with little additional morbidity. Optimal treatment for the patient with unresectable disease is currently still debatable. Our experience, as well as others, suggests that patients who have unresectable disease by radiologic or laparoscopic evaluation are better served by nonsurgical internal biliary decompression. We currently favor nonoperative treatment with self-expandable wire mesh stents over operative biliary enteric bypass for nonresectional candidates. Patients who underwent resection who develop local recurrence with biliary obstruction also can be managed with metallic stents across the obstructed hepaticojejunostony to provide an additional period of symptomatic palliation.
无可争议的是，切除手术与胆管癌患者的生存期延长相关，并且是实现治愈的唯一机会。同样重要的是，在切除手术时能够实现显微镜下的切缘阴性。在肝门血管骨骼化的同时广泛应用肝切除术，可能会提高实现无瘤切缘的能力，并且可以在几乎不增加额外发病率的情况下进行。目前，对于不可切除疾病患者的最佳治疗方法仍存在争议。我们以及其他人的经验表明，经影像学或腹腔镜评估为不可切除疾病的患者，非手术性胆管内减压治疗效果更佳。对于不适合切除手术的患者，我们目前更倾向于使用自膨式金属丝网支架进行非手术治疗，而非手术性胆肠吻合术。接受切除手术的患者若出现局部复发并伴有胆管梗阻，也可通过在梗阻的肝空肠吻合口处放置金属支架来进行治疗，以提供额外一段时间的症状缓解。
