Sasaki A, Aramaki M, Kawano K, Morii Y, Nakashima K, Yoshida T, Kitano S
Department of Surgery I, Oita Medical University, Japan.
Br J Surg. 1998 Sep;85(9):1206-9. doi: 10.1046/j.1365-2168.1998.00815.x.
Classification of macroscopic appearance and standard operative procedures for intrahepatic cholangiocarcinoma (ICC) are still controversial.
The mode of spread of 12 resected ICCs was examined by light microscopy, and the appropriate operative procedures for the various tumours were considered.
Macroscopically, nine tumours were classified as mass-forming type and three as periductal infiltrating type. All patients were treated by major hepatectomy; resection of the extrahepatic bile duct was included in two cases of the periductal infiltrating type. Microscopically, invasion into the portal vein, intrahepatic metastasis and perineural or lymphatic vessel invasion occurred in none, one and all of three tumours of the periductal infiltrating type and in eight, six and six of nine tumours of the mass-forming type.
ICC of the periductal infiltrating type has a tendency to spread along Glisson's sheath via lymphatic vessels. By contrast, ICC of the mass-forming type tends to invade the liver via the portal vein system; such tumours begin to invade Glisson's sheath through the lymphatic vessels when the tumour has increased in size. Therefore, major hepatectomy with combined resection of the extrahepatic bile duct should be performed for all ICCs of the periductal infiltrating type and for those of the mass-forming type with invasion of Glisson's sheath.
肝内胆管癌（ICC）的大体外观分类及标准手术操作仍存在争议。
通过光学显微镜检查12例切除的ICC的扩散方式，并考虑针对不同肿瘤的合适手术操作。
大体上，9个肿瘤被分类为肿块形成型，3个为导管周围浸润型。所有患者均接受了肝大部切除术；导管周围浸润型的2例患者还包括肝外胆管切除。显微镜下，导管周围浸润型的3个肿瘤中无一例侵犯门静脉、发生肝内转移以及神经或淋巴管侵犯，而肿块形成型的9个肿瘤中有8个、6个和6个分别出现上述情况。
导管周围浸润型ICC有通过淋巴管沿Glisson鞘扩散的倾向。相比之下，肿块形成型ICC倾向于通过门静脉系统侵犯肝脏；当肿瘤增大时，此类肿瘤开始通过淋巴管侵犯Glisson鞘。因此，对于所有导管周围浸润型ICC以及侵犯Glisson鞘的肿块形成型ICC，均应行肝大部切除术并联合肝外胆管切除。
