Current surgical treatment for bile duct cancer

Since extrahepatic bile duct cancer is difficult to diagnose and to cure,a safe and radical surgical strategy is needed.In this review,the modes of infiltration and spread of extrahepatic bile duct cancer and surgical strategy are discussed.Extended hemihepatectomy,with or without pancreatoduodenectomy(PD),plus extrahepatic bile duct resection and regional lymphadenectomy has recently been recognized as the standard curative treatment for hilar bile duct cancer.On the other hand,PD is the choice of treatment for middle and distal bile duct cancer.Major hepatectomy concomitant with PD(hepatopancreatoduodenectomy)has been applied to selected patients with widespread tumors.Preoperative biliary drainage(BD)followed by portal vein embolization(PVE)enables major hepatectomy in patients with hilar bile duct cancer without mortality.BD should be performed considering the surgical procedure,especially,in patients with separated intrahepatic bile ducts caused by hilar bile duct cancer.Right or left trisectoriectomy are indicated according to the tumor spread and biliary anatomy.As a result,extended radical resection offers a chance for cure of hilar bile duct cancer with improved resectability,curability,and a 5-year survival rate of 40%.A 5-year survival rate has ranged from 24% to 39% after PD for middle and distal bile duct cancer.

胆管癌胆管胆汁中糖蛋白糖链结构变化及其酶学机制

目的：研究胆管癌胆汁中糖蛋白糖链结构的变化及其酶学机制,探讨胆汁中糖蛋白成份及其糖链结构的改变在良恶性胆道病变中的鉴别诊断价值。方法：运用各种生化技术将一组恶性胆道病变(胆管癌27例、胆囊癌9例、壶腹癌5例)和20例良性胆道病变所致梗阻性黄疸病人胆管胆汁中的蛋白分离出来,进行糖蛋白定性。采用制备好的HRP标记凝集素探针(DSA-HRP、WGA-HRP、LCA-HRP、ConA-HRP)分别对良恶性胆管胆汁中的糖蛋白的糖链结构进行检测和分析。将已分离、纯化和鉴定好的GnT-Ⅲ、Ⅳ、Ⅴ的最适受体底物与上述胆管癌、胆囊癌组织及良性胆管组织的酶液进行反应,再以HPLC测定组织中GnT-Ⅲ、Ⅳ、Ⅴ的活力。结果：良恶性胆道病变的胆汁中糖蛋白的糖链结构存在明显差异,胆管癌胆汁中糖蛋白的糖链结构的变化主要表现为天线数和核心岩藻糖的明显增多,还可能伴有平分型GlcNAc的增多。GnT-Ⅴ、Ⅳ、Ⅲ的活力在胆管癌和胆囊癌癌组织中明显高于良性对照组,尤以GnT-Ⅴ、Ⅲ活力增高更明显。结论：胆管癌胆汁中的糖蛋白及其糖链结构的变化可能对胆管癌的定性诊断有一定价值。胆管癌组织中糖基转移酶活力的改变是胆汁中糖蛋白糖链结构变化的酶学机制。