论文部分内容阅读
胆管癌分为肝内、肝门、远端及弥漫型四种。弥漫型胆管癌是指肿瘤浸润较广泛或浸润全部肝外胆管,有两种类型,即浅表扩散性和弥漫浸润性。浅表扩散是指胆管癌从主瘤灶沿黏膜扩散>20 mm者,常见于胆管乳头状癌及其他分化好的腺癌中,恶性程度较低,预后较好。弥漫浸润是指胆管癌累及从肝门至远端的全部肝外胆管,病理学分期晚,预后差。应用MRI、多层螺旋CT以及胆管镜等检查,大多数病人可准确诊断胆管癌的大体类型及胆管累及的程度,特别是在浅表扩散性胆管癌中明确胆管黏膜累及的范围至关重要,这有助于设计精准的手术方案。弥漫型胆管癌需行包括大范围肝切除的肝胰十二指肠切除术者,术前大多需行胆道引流和门静脉栓塞,以增加手术的安全性及防止术后发生肝功能衰竭。
Cholangiocarcinoma is divided into intrahepatic, hepatic, distal and diffuse four. Diffuse cholangiocarcinoma refers to the more extensive or invasive tumor infiltration of extrahepatic bile duct, there are two types, namely superficial diffusivity and diffuse infiltration. Superficial spread refers to the spread of cholangiocarcinoma along the mucosa from the main tumor focus> 20 mm, common in biliary papillary carcinoma and other well-differentiated adenocarcinomas, the lower the degree of malignancy, the prognosis is good. Diffuse infiltration refers to the bile duct cancer involving the entire extrahepatic bile duct from the hilum to the distal pathological staging late, poor prognosis. Application of MRI, multi-slice spiral CT and cholangioscopy and other tests, most patients can accurately diagnose the general type of cholangiocarcinoma and bile duct involvement, especially in superficial diffuse cholangiocarcinoma clear bile duct mucosa involved in the scope is essential, This helps to design a precise surgical plan. Diffuse cholangiocarcinoma requires a wide range of hepatectomy including liver resection, preoperative biliary drainage and portal vein embolization are mostly required to increase the safety of surgery and prevent postoperative liver failure.