肝门部胆管癌影像学诊断研究现状

doi:10.3969/j.issn.1672-5069.2021.02.039

摘要/Abstract

摘要： 目的肝门部胆管癌(HCCA)是胆道系统肿瘤中常见的恶性肿瘤之一。随着临床认识、检验和影像学检查技术的提高,HCCA诊断报道病例数在增加。由于早期缺乏特异性表现,一经发现多数为晚期患者,导致根治性切除率低,预后差。因此,对具有高危因素的患者,早期筛查和诊断非常重要。目前,影像学检查成为诊断和鉴别诊断HCCA的重要手段。本文重点讨论影像学早期筛查和诊断HCCA的有关进展。

关键词: 胆管肿瘤, Klatskin肿瘤, 影像学检查, 文献复习

Abstract: Objective Hilar cholangiocarcinoma (HCCA) is one of the common malignant tumors in biliary system. The reported cases of HCCA increases gradually as the intensive application of imaging examination. Due to the lack of specific manifestations in the early stage of the tumor, most patients are found to be with advanced disease, resulting in a low radical resection and poor prognosis. Therefore, early screening and diagnosis is the top priority for individuals with high risk factors. At present, the imaging detection has become an important means of diagnosis and differentiation of HCCA. In this article, we review the early imaging screening and diagnosis of HCCA.

Key words: Bile duct neoplasms, Klatskin neoplasms, Imaging, Literature review

王虬玥, 国麟祺, 何其勇. 肝门部胆管癌影像学诊断研究现状[J]. 实用肝脏病杂志, 2021, 24(2): 301-304.

Wang Qiuyue, Guo Linqi, He Qiyong. Imaging diagnosis of hilar cholangiocarcinoma[J]. Journal of Practical Hepatology, 2021, 24(2): 301-304.

参考文献

[1] Tyson GL, El-Serag HB. Risk factors for cholangiocarcinoma. Hepatology, 2011, 54(1):173-184.
[2] Welzel Tania M,Graubard Barry I,El-Serag Hashem B, et al. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma in the United States: a population-based case-control study.Pub Med,2007,5(10):213-217.
[3] Yachimski P , Pratt D S . Cholangiocarcinoma: Natural history, treatment, and strategies for surveillance in high-risk patients. J Clin Gastroenterol, 2008, 42(2):178-190.
[4] Ijin J , Min L J , Hee Y J . Imaging diagnosis of intrahepatic and perihilar cholangiocarcinoma: Recent advances and challenges. Radiology, 2018:171187-171192.
[5] 黄强,杨骥,林先盛,等.CT三维重建在肝门部胆管癌的诊疗中的应用价值.中国普通外科杂志,2017,26(8):960-967.
[6] 王祥宇, 陆录, 钦伦秀. 肝门部胆管癌临床治疗进展. 中华肝脏外科手术学电子杂志, 2018, 7(4):253-257.
[7] 倪其泓, 张赟和, 陈炜, 等.Bismuth Ⅳ型肝门部胆管癌根治术. 中华消化外科杂志, 2016, 15(4):380-384.
[8] Nagino M , Ebata T , Yokoyama Y , et al. Evolution ofsurgical treatment for perihilar cholangiocarcinoma: A single-center 34-year review of 574 consecutive resections. Ann Surg, 2012, 258(1):129-140.
[9] Razumilava N , Gores G J . Cholangiocarcinoma. Lancet, 2014, 383(9935):2168-2179.
[10] 李相成,江王杰.肝门部胆管癌诊治进展.腹部外科,2019,32(01):7-12.
[11] Zen Y , Adsay N V , Bardadin K , et al. Biliary intraepithelial neoplasia: an international interobserver agreement study and proposal for diagnostic criteria.Modern Pathol, 2007, 20(6):701-709.
[12] Klempnauer J,Ridder G J,Werner M,et al. What constitutes long-term survival after surgery for hilar cholangiocarcinoma? Pub Med,1997,79(1):321-328.
[13] Miyazaki M , Ito H , Nakagawa K , et al. Aggressive surgical approaches to hilar cholangiocarcinoma: Hepatic or local resection? Surgery, 1998, 123(2):1-136.
[14] Alfredo G, Andrea R,Tommaso C, et al.Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. Pub Med,2009,33(6):421-428.
[15] 石景森, 何平. 肝门部胆管癌的诊断. 肝胆外科杂志, 2001, (2):83-84.
[16] Dong K, Wang G P .Hilar cholangiocarcinoma: Pathology and tumor biology. Front Med China, 2010, 4(4):371-377.
[17] Burak K , Angulo P , Pasha T M , et al. Incidence andrisk factors for cholangiocarcinoma in primary sclerosing cholangitis. Am J Gastroenterol, 2004, 99(3):523-526.
[18] Boberg K M , Bergquist A , Mitchell S , et al. Cholangiocarcinoma in primary sclerosing cholangitis: Risk factors and clinical presentation. Scand J Gastroenterol, 2002, 37(10):1205-1211.
[19] Lazaridis K N, Gores G J. Primary sclerosing cholangitis and cholangiocarcinoma. 2006, 26(1):42-51.
[20] Charatcharoenwitthaya P , Enders F B , Halling K C , et al. Utility of serum tumor markers, imaging, and biliary cytology for detecting cholangiocarcinoma in primary sclerosing cholangitis. Hepatology, 2008, 48:341-347.
[21] Blechacz B , Komuta M , Roskams T , et al. Clinical diagnosis and staging of cholangiocarcinoma. Nat Rev Gastroenterol Hepatol, 2011, 8(9):512-522.
[22] Paul A , Kaiser G M , Molmenti E P , et al. Klatskintumors and the accuracy of the Bismuth-Corlette classification. Am Surg, 2011, 77(12):1695-1699.
[23] Suarez-Munoz M A , Fernandez-Aguilar J L , Sanchez-Perez B , et al. Risk factors and classifications of hilar cholangiocarcinoma. World J Gastrointest Oncol, 2013, 5(7):132.
[24] 李相成, 冯勤超. 肝门部胆管癌的进展与争议. 临床肝胆病杂志, 2019(12):341-344.
[25] 倪其泓,王坚.肝门部胆管癌诊断和治疗指南(2013版)的解读与思考.肝胆胰外科杂志,2015,27(6):450-454.
[26] Oliveira I S , Kilcoyne A , Everett J M , et al. Cholangiocarcinoma: classification, diagnosis, staging, imaging features, and management. Abdom Radiol, 2017, 42(6):1637-1649.
[27] Valls C , Ruiz S , Martinez L , et al. Radiological diagnosis and staging of hilar cholangiocarcinoma. World J Gastrointest Oncol, 2013(7):10-21.
[28] Hann L E , Greatrex K V , Bach A M , et al. Cholangiocarcinoma at the hepatic hilus: sonographic findings. Am J Roentgenol, 1997, 168(4):985-989.
[29] Xu H X , Chen L D ,Xie X Y , et al. Enhancement pattern of hilar cholangiocarcinoma: Contrast-enhanced ultrasound versus contrast-enhanced computed tomography. Eur J Radiol, 2009, 75(2):197-202.
[30] Ruys A T , Beem B E V , Engelbrecht M R W , et al. Radiological staging in patients with hilar cholangiocarcinoma: A systematic review and meta-analysis. Brit J Radiol, 2012, 85(1017):1255-1262.
[31] Lee H Y , Kim S H , Lee J M , et al. Preoperativeassessment of resectability of hepatic hilar cholangiocarcinoma: Combined CT and cholangiography with revised criteria1. Radiology, 2006, 239(1):113-121.
[32] Aloia T A , Charnsangavej C , Faria S , et al. High-resolution computed tomography accurately predicts resectability in hilar cholangiocarcinoma. Am J Surg, 2007, 193(6):1-706.
[33] Lazaridis K N ,Gores G J . Cholangiocarcinoma. Gastroenterology, 2005, 128(6):1655-1667.
[34] Feydy A , Vilgrain V , Denys A , et al. Helical CT assessment in hilar cholangiocarcinoma: correlation with surgical and pathologic findings. Am J Roentgenol, 1999, 172(1):73-77.
[35] Choi B I , Lee J M , Han J K . Imaging of intrahepatic and hilar cholangiocarcinoma. Abdom Imaging, 2004, 29(5):548-557.
[36] 朱云峰,李建生,马金良, 等.三维重建技术在肝门部胆管癌术前评估中的价值.中国普通外科杂志,2016,25(2):175-180.
[37] Lee S S , Kim M H , Lee S K , et al. MR cholangiography versus cholangioscopy for evaluation of longitudinal extension of hilar cholangiocarcinoma. Gastrointest Endosc, 2002, 56(1):25-32.
[38] Masselli G , Manfredi R , Vecchioli A , et al. MR imaging and MR cholangiopancreatography in the preoperative evaluation of hilar cholangiocarcinoma: correlation with surgical and pathologic findings. Eur Radiol, 2008, 18(10):2213-2221.
[39] Lee M G , Park K B , Shin Y M , et al. Preoperativeevaluation of hilar cholangiocarcinoma with contrast-enhanced three-dimensional fast imaging with steady-state precession magnetic resonance angiography: Comparison with intraarterial digital subtraction angiography. World J Surg, 2003, 27(3):278-283.
[40] Matos C , Serrao E , Bali M A .Magnetic resonance imaging of biliary tumors. Magn Reson Imaging Clin North Am, 2010, 18(3):477-496.
[41] Sun H Y , Lee J M , Park H S , et al. Gadoxetic acid-enhanced MRI with MR cholangiography for the preoperative evaluation of bile duct cancer. J Magnet Reson Imaging, 2013, 38(1):138-147.
[42] Jhaveri K S , Hosseini-Nik H . MRI of cholangiocarcinoma. J Magnet Reson Imaging, 2014, 42(5):412-416.
[43] 方驰华,刘允怡,曾宁, 等.肝门部胆管癌三维可视化精准诊治中国专家共识(2019版).中国实用外科杂志,2020,40(3):260-266.
[44] Yoon J H , Lee S M , Kang H J , et al. Clinicalfeasibility of 3-dimensional magnetic resonance cholangiopancreatography using compressed sensing: Comparison of image quality and diagnostic performance. Investig Radiol, 2017, 52(10):1.
[45] Kim J Y , Kim M H , Lee T Y , et al. Clinicalrole of \r, 18\r, F-FDG PET-CT in suspected and potentially operable cholangiocarcinoma: A prospective study compared with conventional imaging. Am J Gastroenterol, 2008, 103(5):1145-1151.
[46] Joo I , Lee J M , Lee D H , et al. Preoperativeassessment of pancreatic cancer with FDG PET/MR imaging versus FDG PET/CT plus contrast-enhanced multidetector CT: A prospective preliminary study. Radiology, 2016,53:152798.
[47] Lee D H , Lee J M . Whole-body PET/MRI for colorectal cancer staging: Is it the way forward? J Magnet Reson Imaging, 2016,54:322-326.
[48] Chapman R, Fevery J, Kalloo A, et al. Diagnosis and management of primary sclerosing cholangiti]. Hepatology, 2010, 51(2):416-419.
[49] 殷晓煜.肝门部胆管癌术前行胆道引流术减轻黄疸的争议与策略.中华消化外科杂志,2018,43(3):229-232.
[50] Soares K C , Kamel I , Cosgrove D P , et al. Hilar cholangiocarcinoma: diagnosis, treatment options, and management. HepatobiliarySurg Nutrit,2014,53(1):18-34.
[51] Chryssou E , Guthrie J A , Ward J , et al. Hilar cholangiocarcinoma: MR correlation with surgical and histological findings. Clin Radiol, 2010, 65(10):781-788.