肝门部胆管癌的诊治进展

Diagnosis and treatment of hilar cholangiocarcinoma

肝门部胆管癌(HCCA)是肝胆外科领域的研究热点和难点。HCCA是最常见的胆管癌类型, 具有早期临床表现不典型、进展快、预后差的特点。HCCA无特定的标志物, 其术前诊断和评估主要依靠影像学检查。外科手术治疗仍是主要治疗手段, 但多数患者就诊时已失去手术切除的机会。近年来, 国内外就HCCA的诊断和治疗进行了大量研究, 对于HCCA的疗效有所改善。围手术期的处理包括术前引流方式的选择、围手术期放化疗等改善了患者的术后生存。其中, 术前放化疗在肝移植领域的应用取得了相当不错的效果。可选择的术式从传统的胆管切除术及肝切除术衍生出其他复杂的术式。靶向治疗和免疫治疗为HCCA提供了新的治疗手段。本文就HCCA的诊断和多模式治疗作一综述。

Hilar cholangiocarcinoma(HCCA)is a hotpot and a dificult point inthe field of hepatoiliary surgery.HCCA is the most common type of cholangiocarcinoma and is characterized by alypical ealy clinical manifestations,rapid progresion and por prognosis.There is no speeific marker for HCCA and its preoperative diagnosis and evaluation mainly relies on imaging examination.Surgical treatment is stil the main treatment,but most patients have lost the opportunity of surgical resection by the time of treatment.In recent years,a large number of studies have been conducted on the diagnosis and treatment of HCCA at home and abroad,and the eficacy of HCCA has been improved.Perioperative management,including the selection of preoperative drainage and perioperative chemoradiotherapy and others,improved postoperative survival.Among them,the application of preoperative radiotherapy and chemotherapy in the field of liver transplantation has achieved quite good results.Targeted therapy and immunotherapy have provided new treatment methods for HCCA.This paper reviews the diagnosis and multimodal reatment of HCCA.