肝移植能否用于治疗胆管癌

Is liver transplantation indicated for cholangiocarcinoma

胆管癌包括肝内和肝外胆管癌，传统的治疗方法首选根治性手术切除，胆管癌恶性程度高，手术切除率低，病死率高，早期肝移植治疗胆管癌的效果差，多数患者术后早期复发，长期生存率较低，近年随着供体短缺问题越来越严重，一些移植中心已将胆管癌作为肝移植的禁忌证，但也有报道反对这一观点，认为结合放化疗等辅助治疗的肝移植要优于手术切除，能明显提高患者生存率。本文结合文献和我院经验，对肝移植能否用于治疗胆管癌这一有争论的问题进行简单讨论。

Cholangiocarcinoma comprises intrahepatic cholangiocarcinoma and extrahepatic cholangiocarcinoma, and the most optimizing traditional therapy is radical surgical resection. Unfortunately, cholangiocaricinoma is a predominantly fatal cancer, which can be difficult to diagnose and to treat, and the resection rate is low while the mortality rate is still high. In the past decades, liver transplantation alone for unresectable cholangiocarcinoma is often associated with early tumor relapse and limited survival. Because of these discouraging results and shortage of donor liver, many medical centers have abandoned liver transplantation for cholangiocarcinoma. However, there are some reports against this viewpoint, insisting that adjuvant chemotherapy and radiotherapy after liver transplantation could perhaps improve the survival outcome and is superior to surgical resection. In an attempt to solve the argument, we review literature and share our experience here to discuss whether liver transplantation is indicated for cholangiocarcinoma or not.