浅谈特殊部位肝内胆管癌的诊疗策略

Diagnostic and treatment strategies for intrahepatic cholangiocarcinoma in special anatomical locations

肝内胆管癌(ICC)近年来发病率呈明显上升趋势,临床上越来越予以重视。相较于肝门部和肝外胆管癌,ICC早期发病隐匿,临床症状出现较晚。特殊部位ICC,常指毗邻大血管、胆管汇合部等处的中央型ICC,即肝门型和尾状叶型ICC,其侵袭性和复杂程度较周围型ICC更为严重。特殊部位ICC大部分初诊时由于剩余肝体积不足、黄疸、淋巴结转移或血管侵犯等,不具备根治性手术的条件。近年来随着ICC系统治疗的快速发展,部分患者经综合治疗后降期从而获得根治性手术机会,但仍需更多证据证实其疗效。

The incidence rate of intrahepatic cholangiocarcinoma(ICC)has been increasing significantly in recent years,which has been taken seriously in clinical practice.Compared with hilar and extrahepatic cholangiocarcinoma,ICC tends to have an insidious onset,with clinical symptoms appearing at a later stage.ICC in special anatomical locations often refers to central-type ICC in proximity to major blood vessels and the confluence of bile ducts,namely hilar-type ICC and caudate lobe-type ICC,and such ICC has higher degrees of invasiveness and complexity compared with peripheral-type ICC.At the time of initial diagnosis,most patients with ICC in special anatomical locations do not have the opportunity for radical surgery due to the factors such as insufficient residual liver volume,jaundice,lymph node metastasis,and vascular invasion.With the rapid development of systemic therapy for ICC in recent years,some patients are downstaged after comprehensive therapy and thus obtain the opportunity for radical surgery,but more evidence is still needed to verify the efficacy of such approaches.