肝内胆管癌术后复发的治疗

Treatment of recurrent intrahepatic cholangiocarcinoma after liver resection

影响肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)肝切除术后远期生存的主要因素是肝内复发和肝外转移。再切除适用于复发性肿瘤单发、至复发时间较长、肝功能良好的病人,但术后再复发率仍较高。对于术后较早期肝内复发、肿瘤直径不超过3 cm、数目不超过3个的ICC,消融治疗可达到与再切除相似的远期预后。对于不适合再切除或消融的肝内复发ICC,可考虑行经肝动脉栓塞化疗(tansarterial arterial chemoembolization,TACE)或钇-90经肝动脉放射性栓塞。对于术后发生肝外转移的ICC,应联合消融、TACE、系统性化疗、靶向治疗以及姑息治疗等多种治疗手段,以进一步延长病人的生存时间。

The main prognostic factor affecting the long-term survival after liver resection for intrahepatic cholangiocarcinoma(ICC)are intrahepatic recurrence and extrahepatic metastasis.Re-resection is suitable for patients with single recurrent tumor,a longer interval of time to recurrence,and good liver function,but the postoperative recurrence rate is still high.For ICC with early postoperative recurrence,tumor diameter no more than 3 cm and number no more than 3,ablation therapy can achieve similar long-term prognosis as re-resection.For the intrahepatic recurrence not suitable for resection or ablation,transcatheter arterial chemoembolization(TACE)or transcatheter arterial yttrium-90(90 Y)radioembolization can be considered.For the extrahepatic metastases,multidisciplinary treatment with ablation,TACE,systemic chemotherapy,targeted drugs and supportive care should be used to further prolong the survival time.