肝门部胆管癌术前诊断及胆道引流策略的现状与争议

Current status and controversy about clinical diagnosis and preoperative biliary drainage for perihilar cholangiocarcinoma

肝门部胆管癌(pCCA)是一种典型的沉默癌,早期诊断困难。虽然当前已具备先进的影像成像技术并且发现了多种与pCCA发生发展有关的分子标志物,但尚未发现能特异性诊断pCCA的非侵入性检查方法。近期有多项研究证实紫藤多花凝集素唾液酸化的黏蛋白1对胆管癌的诊断效能优于传统的血清肿瘤标志物糖链抗原199。多篇荟萃分析证实术前常规胆道引流并不能使pCCA患者获益,而对于并发急性梗阻性化脓性胆管炎等需要接受术前胆道引流术的患者而言,经皮肝穿刺胆道引流术相关的感染性并发症明显低于内镜下胆道引流术。本研究在系统检索近6年被中国知网、PubMed及Web of Science收录的有关p CCA诊疗的文献基础上,就当前有关pCCA术前诊断及胆道引流术的争议及研究进展加以概述。

Perihilar cholangiocarcinoma(pCCA)is a typically silent cancer difficult to diagnose at early stage.A great number of molecular biomarkers associated with the pathogenesis of p CCA have been certified,however,no single type of non-invasion diagnostic tools with a high level of accuracy to verify the diagnoses of pCCA have been found,even with an currently advanced imaging technology and complete diagnostic workup.A handful of studies have reported that the diagnostic capacity of wsteria floribunda agglutinin-sialylated mucin1 was greater than that of CA19-9 in patients with cholangiocarcinoma.In light of the results of the recently published Meta-analyses,routine preoperative biliary drainage cannot benefit patients with resectable pCCA or malignant obstructive jaundice.Nevertheless,it is true that percutaneous transhepatic biliary drainage would reduce the incidence of infectious complications significantly for patients who need biliary drainage for acute suppurative cholangitis or other conditions.The study was carried out to comprehensively review the clinical diagnosis and preoperative biliary drainage of pCCA,based on a systematic search of the China National Knowledge Infrastructure,PubMed and Web of Science,in order to identify reports focusing on surgical treatment of pCCA published in the last six years.