膽管癌外科治療的奧踐和存在問(wèn)題的探討概Biliaryductcancer/Cholangiocarcinoma定義:發(fā)生于肝外膽管(含左右肝管主干至膽總管下端)惡性腫瘤的總稱。不包括肝內(nèi)膽管癌、肝臟膽管細(xì)胞癌、膽囊癌、乏特壺腹癌發(fā)生部位:上段膽管瘟中段膽管癌下段膽管癌爭(zhēng)論Figur1:ClaasiseationofChelangieesreinema源于膽管上皮的惡性腫瘤—膽管癌(含肝內(nèi)、肝外膽管癌侵RepooucecwinpensiontrumPatelT-Choancarcnoma,hacinPactGasl0aL20063134及肝門(mén)部膽管)●Intra-hepaticCholangiocarcinomaExtra-hepaticCholangiocarcinoma流行病學(xué)資料6os--70sBileductcancer=3,000/yrHighestincidenceineGallBladdercancer=6,goo/yJapan,Israel,andNativeamericansHepatocellularCa=15,ooo/yr●IncreasedintheUSA●M/F=3/2Rightorlefthepaticduct%●Bifurcation=20%USMazenhassanainmd●Proximalcbd=30%手術(shù)切除率10%DistalCBD=30%病因?qū)W資料病因未明多病因高危因素膽管結(jié)石膽道蛔蟲(chóng)膽管炎癌中華分枝睪吸蟲(chóng)先天性膽管囊狀擴(kuò)張癥■→》癌(癌變率達(dá)25%~15%)膽管癌治療與臨床指南美國(guó)癌癥聯(lián)合會(huì)NCCN●歐洲腫瘤醫(yī)學(xué)會(huì)EMSO英國(guó)肝臟病協(xié)會(huì)BASL其他NHSHospitalguidlineCietprehenaiveNCCNGuidelinesVersion2.2012Newark.ExtrahepaticCholangiocarcinomaFRMARYTREATMENTnignotprimiidneghemgradirasion'R→3SurveillaneEXTRA2)clinicalpracticeguidelinesofOncolgy21Pupplamant5:ve5-v692010Biliarycancer:ESMOClinicalPracticeGuidelinesfordiagnosis,treatmentandfollow-upF.Eckel.TBrunner&SJelicOnbehalfoftheESMOGuidelinesWorkingGrouKwwkrnecusaatMnwch,Gman"GraysnareafAaaaOnmgyanEaagyyofOxydChuc/MHosp!.hamadMer/chgSar/oBnstituteorOncologya,B電aSet圖inecidenceaparoscopy.UpperandlowerendoscopyhastobeperformeThecrudeincidenceafgallbladderandextrahepaticbiliainpatientswithanisolatedintrahepaticmass.Thestagingiscancer(ICD-10:C23-C24)intheEuropeanUnionis3.2ordingtatheTNM2010systemseratelyfor[Table1),intrhepaticcholangiocarcinomaand-5.4/10000peryearformalesandfemales,respectively.(Table2a).perhilarcholangiocarcinoma(Tabke2b),anddistalge-adjustedmortalityis1.4and1.9/100DO)formalesandcholangiocarcinoma(Tableze)HilarcholangiocarcinomaoLangiocarcinoma(ICD-10.C22isincreasingandmaybeinvolvementofthehepaticductsaccordingtotheBismuth-matedas0,9-1.3and0.4-0.7/100000formalesandales,respectively,as10%r-15%ofprimarylivercanICD-10:C22).Inhigh-riskareasinEurope(southItaly)incidenceisestimatedatupto4.9-7.4and-2.9-4.3/100000treatmentafterincidentalfindingofGUIDELINESGuidelinesforthediagnosisandtreatmentofcholangiocarcinoma:consensusdocumentBRDavidson,RGoldin,SPPerelMCRosenbergas,MRThurs.HWasanclchalangioarcimaeIheneellBileductadenomaandbiliarypauillomalosiCarali'sdiseasecysticdilatationcrdut,lifctimericE73).cysts(aboutswilltransform.withage)helorethetinaldeciesSmokingincreasedriskinassocitionwithPsC)erethetumourcntheassnlwerIlukes-opIiwvE/urwITweandCNE/Ni3/N2515chronictyphoidcarriarixtokinucaxdrikofallhepatobiliarymalignancvidenceawailable(action2.1.3ContextandintentTheseguidelinesarcinkndcdtobringsomitcneyandasinclusiveofiniEhepatEPlssuedate:July2005NHSNationalInstituteforHealthandClinicalExcellencePhotodynamictherapyforbileductcancerGuidance1.2Treatmentoptionsdependonthestage,size,1Currentevidenceonthesafetyandefficacyofpositionandtypeottumour.Bleductcancerisphotodynamictherapy(PDI)farbileductcancernotusualbydiagnosedbeforethesymptomsofesnotappearadequateforthisproceduretoliarobstructionoccur,bywhichtimethebeusedwithoutspecialarrangementsforcorermaybetooadvancedforcurativesurgiGaandforauditorresearchresection.Optionsforpalliatvetreatmentinclude