肝门部胆管癌是一种少见的高度侵袭性胆道肿瘤,发病隐匿,恶性程度高,预后较差,手术切除是目前唯一的根治性治疗方法。随着医疗技术的进步及手术水平的提高,患者根治切除率及术后生存率有所提高,但整体治疗效果仍不佳。本文就肝门部胆管癌的治疗现状及进展作一概述。
Hilar cholangiocarcinoma is a rare highly invasive biliary tumor with concealed onset, high malig-nancy and poor prognosis. Surgical resection is the only radical treatment at present. With the pro-gress of medical technology and the improvement of operation level, the radical resection rate and postoperative survival rate of patients have improved, but the overall treatment effect is still poor. This paper summarizes the current situation and progress of the treatment of hilar cholangiocarci-noma.
Hilar cholangiocarcinoma is a rare highly invasive biliary tumor with concealed onset, high malignancy and poor prognosis. Surgical resection is the only radical treatment at present. With the progress of medical technology and the improvement of operation level, the radical resection rate and postoperative survival rate of patients have improved, but the overall treatment effect is still poor. This paper summarizes the current situation and progress of the treatment of hilar cholangiocarcinoma.
根治性手术切除一直是肝门部胆管癌的主要治疗方法,但对于肿瘤较晚期或者剩余肝体积不足的患者来说,肝移植无疑是一种最好的选择。但最初阶段肝移植的效果并不佳,5年生存率为23%,复发率高达50%以上,其中84%的病人2年内复发 [42]。美国梅奥诊所将新辅助化疗与肝移植相结合,以治疗无法根治性切除的患者。他们在2005年发表的随访结果报告了38名正在进行肝门癌肝移植的患者,5年生存率为82% [43]。与手术切除的患者相比,移植患者的生存率更好,复发率更低。他们近期的研究还证实,原发性硬化性胆管炎相关的肝门胆管癌的效果优于新生型肝门胆管癌患者(5年存活率74% VS 58%,5年复发率22% VS 45%) [44]。在梅奥诊所结果的推动下,其他中心也开始了肝门胆管癌的肝移植研究。Ethun等人通过多中心的研究结果证实,在这些医疗中心,接受肝移植的患者的5年生存率(64% VS 18%)高于行根治性切除的患者。他们的研究还证实,在肿瘤较小且区域淋巴结阴性的肝门胆管癌患者行肝移植,5年生存率更高 [45]。Zaborowski等根据梅奥团队的经验进行了单中心的回顾性研究,26例肝门胆管癌患者接受了新辅助化疗后完成了肝移植术,术后1,3,5年存活率分别为81%,69%和55%,获得病理完全缓解患者的中位生存期为83.8个月,残余肿瘤组患者的中位生存时间为20.9个月,总体中位生存时间为53个月 [46]。
刘 军,龚建平,熊 彬. 肝门部胆管癌的治疗现状及进展Treatment Status and Progress of Hilar Cholangiocarcinoma[J]. 临床医学进展, 2022, 12(06): 5375-5381. https://doi.org/10.12677/ACM.2022.126779
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