结石与非结石性肝内胆管癌肝切除术的围手术期管理差异

Differences in perioperative management between patients with hepatolithiasis-associated and nonhepatolithiasis-associated intrahepatic cholangiocarcinoma undergoing hepatectomy

肝胆管结石是指发生在左右肝管汇合部以上的结石病。该病可引起胆道梗阻及胆汁淤积,继而增加结石的发生率,而机械梗阻及反复炎症刺激将加重胆道梗阻,从而引起一系列严重的并发症,如胆管炎、肝萎缩、肝硬化等,甚至诱发胆管癌变。肝内胆管癌(ICC)是常见的肝脏恶性肿瘤,其起源于肝内胆管上皮,有着恶性程度高、手术根治率低、术后复发率高、预后差等特点,因此也成为影响国民健康的重大疾病。ICC的病因目前尚未明确,众多研究表明,肝胆管结石是ICC的高危因素之一,在结石长期的机械刺激及慢性炎症刺激下,胆管上皮沿着增生修复、不典型性增生、癌前病变的方向发展,并在此基础上,最终演变成ICC。因此,根据致病因素与结石相关程度将ICC分为结石性肝内胆管癌(HICC)和非结石性肝内胆管癌(NHICC)。外科手术仍是ICC的主要治疗方式,早期根治性肝切除术可有效提高ICC患者的总体生存率,改善预后。作为肝内胆管结石的高发地区,近年来HICC在我国的发病率也随之攀升,因而针对HICC的综合管理具有十分重要的临床意义。基于上述背景,本文以HICC为中心,归纳出HICC与NHICC的围手术期处理要点差异,以期为HICC患者在整个肝切除术的围手术期内提供个体化、精准化的围手术期管理方式,从而达到提高诊断率、精准治疗、加速康复、改善预后的目的。

Hepatolithiasis is a type of lithiasis that occurs above the confluence of the left and right hepatic ducts.This condition can cause bile duct obstruction and stasis,increasing the likelihood of stone formation.Mechanical obstruction and recurrent inflammatory stimuli can exacerbate bile duct blockage,leading to severe complications such as cholangitis,liver atrophy,cirrhosis,and even the development of cholangiocarcinoma.Intrahepatic cholangiocarcinoma(ICC)is a common malignant liver tumor originating from the intrahepatic bile duct epithelium.It is characterized by high malignancy,low surgical cure rate,high postoperative recurrence rate,and poor prognosis,making it a significant public health concern.The etiology of ICC is still unclear,but numerous studies have indicated that hepatolithiasis is one of the high-risk factors for ICC.Prolonged mechanical and chronic inflammatory stimuli from stones can lead to the development of the bile duct epithelium along the direction of hyperplasia,atypical hyperplasia,and precancerous lesions,eventually evolving into ICC.Based on the degree of association between pathogenic factors and hepatolithiasis,ICC can be classified into hepatolithiasis-related intrahepatic cholangiocarcinoma(HICC)and non-hepatolithiasis-related intrahepatic cholangiocarcinoma(NHICC).Surgical intervention remains the primary treatment for ICC,and early radical hepatectomy can effectively improve the overall survival rate and prognosis of ICC patients.As an area with a high incidence of hepatolithiasis,the incidence of HICC in our country has also been increasing in recent years.Therefore,comprehensive management of HICC is of significant clinical importance.Given the above background,this article focuses on HICC and summarizes the differences in perioperative management between HICC and NHICC.The aim is to provide individualized and precise perioperative management for HICC patients throughout the hepatectomy period to improve the diagnostic rate,provide accurate treatment,accelerate recovery,and enhance the prognosis.