胆管癌的诊断与治疗研究进展

Progress of diagnosis and treatment of cholangiocarcinoma

胆管癌具有较高的恶性程度和较低的手术切除率,加之术后辅助化疗和靶向治疗药物并不成熟,导致胆管癌患者的病死率较高,长期预后较差。随着目前的临床诊疗水平的提高、术前评估和外科技术的发展,胆管癌的诊断和治疗已取得了一些发展进步;胆管癌早期缺乏特异性表现,因此患者被诊断时已失去R0切除机会,早期诊断可提高患者R0切除及术后长期生存率,可通过对比增强超声、增强磁共振、正电子发射计算机断层显像等提高诊断准确性。在治疗上胆管癌仍以综合治疗为主,对于可切除胆管癌争取行R0切除,发生远处转移的胆管癌可结合新辅助化疗后根据复查情况决定是否可行手术治疗、术后联合化疗、分子靶向治疗、立体定向放射治疗等综合方案以期提高患者长期生存率。本文就胆管癌的发病机制、诊断及治疗的新进展作一综述。

Due to the high degree of malignancy and low surgical resection rate of cholangiocarcinoma,as well as the immaturity of postoperative adjuvant chemotherapy and targeted therapy drugs,the mortality rate of patients with cholangiocarcinoma is high and the long-term prognosis is poor.With the improvement of clinical diagnosis and treatment,preoperative evaluation and surgical technique,the diagnosis and treatment of cholangiocarcinoma have made some progress.The early stage of cholangiocarcinoma is lack of specific manifestations,so the patient has lost the opportunity of R0 resection when diagnosed.Early diagnosis can improve the patient′s R0 resection and long-term survival after surgery.The diagnostic accuracy can be improved by contrast enhanced ultrasound,enhanced magnetic resonance,positron emission tomography PET,etc.Dominated by comprehensive therapy in the treatment of bile duct carcinoma,strive for R0 resection for resectable cholangiocarcinoma,distant metastasis occurred after bile duct carcinoma can be combined with new adjuvant chemotherapy according to the review situation decides whether it is feasible to surgery,postoperative chemotherapy,molecular targeted therapy,body directional radiation therapy,and other comprehensive solutions in order to improve the long-term survival rate.This article reviews the recent progress in the pathogenesis,diagnosis and treatment of cholangiocarcinoma.