肝内胆管癌的临床诊断策略

陈志升; 唐陈伟; 汤朝晖; 童焕军; 金志伟

doi:10.3969/j.issn.1001-5256.2019.12.005

肝内胆管癌的临床诊断策略

DOI: 10.3969/j.issn.1001-5256.2019.12.005

1. 上海市第八人民医院普外科
2. 上海交通大学医学院附属新华医院普外科

详细信息

中图分类号: R735.8
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出版历程
- 收稿日期: 2019-11-04
- 出版日期: 2019-12-20

Research advances in the clinical diagnosis of intrahepatic cholangiocarcinoma

Department of General Surgery,Shanghai Eighth People's Hospital

摘要

摘要: 肝内胆管癌(ICC)是源于二级及以上分支胆管上皮细胞的肝恶性肿瘤,具有早期症状隐匿,恶性程度较高,病情进展迅速,容易发生淋巴结转移、肝内转移及血管侵犯等特点,患者预后状况极差。早期诊断可提高ICC的根治切除率,改善患者预后。目前,ICC术前诊断主要依靠影像学、实验室检查及病理学检查。此外,近年一些新兴的诊断方法也开始用于ICC的诊断。但组织病理学检查仍是目前明确诊断ICC的唯一方法。本文旨在对ICC的诊断研究最新进展进行综述。
- 胆管肿瘤 /
- 诊断 /
- 临床实验室技术 /
- 诊断显像 /
- 病理学,临床 /
- 分子生物学
Abstract: Intrahepatic cholangiocarcinoma( ICC) is a malignant liver tumor derived from the epithelial cells of the second-or higher-order branch of the bile duct,with the features of insidious early symptoms,high degree of malignancy,rapid disease progression,lymph node metastasis,intrahepatic metastasis,and vascular invasion,and such patients tend to have poor prognosis. Early diagnosis can improve the radical resection rate and prognosis of ICC. At present,the preoperative diagnosis of ICC mainly relies on imaging technology,laboratory examination,and pathological examination. In addition,some new diagnostic methods have also been used in the diagnosis of ICC in recent years,but histopathological examination remains the only method for the diagnosis of ICC. This article reviews the latest research advances in the diagnosis of ICC.
- bile duct neoplasms /
- diagnosis /
- clinical laboratory techniques /
- diagnostic imaging /
- pathology,clinical /
- molecular biology

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参考文献(46)

[1] BRIDGEWATER J,GALLE PR,KHAN SA,et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma[J]. J Hepatol,2014,60(6):1268-1289.

[2] BERGQUIST A,von SETH E. Epidemiology of cholangiocarcinoma[J]. Best Pract Res Clin Gastroenterol,2015,29(2):221-232.

[3] RAZUMILAVA N,GORES GJ. Cholangiocarcinoma[J]. Lancet,2014,383(9935):2168-2179.

[4] LUO X,YUAN L,WANG Y,et al. Survival outcomes and prognostic factors of surgical therapy for all potentially resectable intrahepatic cholangiocarcinoma:A large single-center cohort study[J]. J Gastrointest Surg,2014,18(3):562-572.

[5] CHEN ZS,ZHOU XP,LIN PY,et al. Research progress in prognostic factors of intrahepatic cholangiocarcinoma[J]. Shanghai Med J,2015,38(3):259-262.(in Chinese)陈志升，周学平，林培艺，等．肝内胆管细胞癌预后因素的研究进展[J]．上海医学，2015,38(3):259-262.

[6] SAHA SK,ZHU AX,FUCHS CS,et al. Forty-year trends in cholangiocarcinoma incidence in the U. S.:Intrahepatic disease on the rise[J]. Oncologist,2016,21(5):594-599.

[7] TORRE LA,BRAY F,SIEGEL RL,et al. Global cancer statistics,2012[J]. CA Cancer J Clin,2015,65(2):87-108.

[8] LIU ZH,CHEN Z,MA LL,et al. Factors influencing the prognosis of patients with intrahepatic cholangiocarcinoma[J]. Acta Gastroenterol Belg,2012,75(2):215-218.

[9] HUANG ZQ. Development direction of Hepatobiliary Surgery[J].J Surg Theory Pract,2011,16(4):329-331.(in Chinese)黄志强．肝胆管外科的发展方向[J]．外科理论与实践，2011,16(4):329-331.

[10] HWANG S,LEE YJ,SONG GW,et al. Prognostic impact of tumor growth type on 7th AJCC staging system for intrahepatic cholangiocarcinoma:A single-center experience of 659 cases[J]. J Gastrointest Surg,2015,19(7):1291-1304.

[11] LORIA F,LORIA G,BASILE S,et al. Contrast-enhanced ultrasound appearances of enhancement patterns of intrahepatic cholangiocarcinoma:Corelation with pathological findings[J].Updates Surg,2014,66(2):135-143.

[12] ZHANG W,WANG TS,SHANG PZ,et al. Research progresses on diagnosis of cholangiocarcinoma[J]. J Hebei North Univ(Natural Science Edition),2018,34(10):52-55,60.(in Chinese)张伟，王铁山，尚培中，等．胆管癌的诊断研究进展[J]．河北北方学院学报(自然科学版)，2018,34(10):52-55,60.

[13] YUAN HX,WANG WP,CAO JY,et al. Value of contrast-enhanced ultrasound in preoperative evaluation for hilar cholangiocarcinoma[J/CD]. Chin J Med Ultrasound(Electronic edition),2014,11(5):418-422.(in Chinese)袁海霞，王文平，曹佳颖，等．超声造影在肝门部胆管癌术前评估中的应用价值[J/CD]．中华医学超声杂志(电子版)，2014,11(5):418-422.

[14] WU XJ,DAN HJ,SUN L,et al. Characteristics of contrastenhanced ultrasound in diagnosis of patients with intrahepatic cholangiocarcinoma[J]. J Prac Hepatol,2018,21(5):803-804.(in Chinese)武晓静，丹海俊，孙丽，等．肝内胆管细胞癌患者超声造影表现特征分析[J]．实用肝脏病杂志，2018,21(5):803-804.

[15] YAMASAKI S. Intrahepatic cholangiocarcinoma:Macroscopic type and stage classification[J]. J Hepatobiliary Pancreat Surg,2003,10(4):288-291.

[16] HUA XD,FU XB,HAO ZQ,et al. Computed tomographic diagnosis of intrahepatic cholangiocarcinoma[J]. Natl Med J China,2014,94(6):449-451.(in Chinese)华向东，傅熙博，郝志强，等．肝内胆管细胞癌的CT表现特征分析[J]．中华医学杂志，2014,94(6):449-451.

[17] JIA YC. CT diagnosis of intrahepatic mass-forming type cholangiocarcinoma[J]. Imaging Technol,2016,28(2):9-12.(in Chinese)贾玉昌．肝内肿块型胆管细胞癌的CT诊断[J]．影像技术，2016,28(2):9-12.

[18] LUAN DG,NIU HD. Comprehensive diagnosis of intrahepatic peripheral cholangiocarcinoma by CT and MRI[J]. J Imag Res Med Appl,2019,3(16):18-20.(in Chinese)栾德广，牛焕东．CT及MRI对肝内周围型胆管癌综合诊断[J]．影像研究与医学应用，2019,3(16):18-20.

[19] GU FM,WANG ZG,YANG Y,et al. Clinical value of Fluorine-18-fluorodeoxyglucose PET-CT examination in intrahepatic cholangiocarcinoma staging[J]. Chin J Dig Surg,2019,18(5):499-505.(in Chinese)顾方明，汪珍光，杨远，等．18氟-氟代脱氧葡萄糖PET-CT检查在肝内胆管癌分期中的临床价值[J]．中华消化外科杂志，2019,18(5):499-505.

[20] ZHANG J,WU YY,ZUO CJ,et al. Evaluation of the role of18F-FDG PET/CT in the diagnosis of intrahepatic cholangiocarcinoma[J]. Diagn Imag Interv Radiol,2016,25(2):161-166.(in Chinese)张建，吴仪仪，左长京，等．18F-FDG PET/CT对肝内胆管癌的诊断价值研究[J]．影像诊断与介入放射学，2016,25(2):161-166.

[21] XIAO Y. The value of 18F-FDG-PETCT combined with CT enhanced scan in the diagnosis of intrahepatic cholangiocarcinoma[J]. J World Latest Med Inf,2018,18(67):160-162.(in Chinese)肖勇．18F-FDG-PETCT显像结合CT增强扫描在肝内胆管癌诊断中的价值[J]．世界最新医学信息文摘，2018,18(67):160-162.

[22] COSTELLO JR,KALB B,CHUNDRU S,et al. MR imaging of benign and malignant biliary conditions[J]. Magn Reson Imaging Clin N Am,2014,22(3):467-488.

[23] LIU NC. MRI diagnosis of intrahepatic cholangiocarcino. ma[J]. J Pract Med Imag,2015,16(3):185-187.(in Chinese)刘宁川．肝内胆管癌的磁共振成像诊断价值[J]．实用医学影像杂志，2015,16(3):185-187

[24] SUN YL,ZHANG YC. Application of CT,MRCP and ERCP in diagnosis and treatment of hilar cholangiocarcinoma[J]. J Pract Med,2010,26(1):97-99.(in Chinese)孙玉亮，张迎春．CT、MRCP及ERCP在肝门部胆管癌诊治中的应用[J]．实用医学杂志，2010,26(1):97-99.

[25] LI J. MRI features of highly differentiated intrahepatic cholangiocarcinoma[J]. China Digital Med,2019,14(1):47-49.(in Chinese)李杰．高分化肿块型肝内胆管细胞癌的MRI特征[J]．中国数字医学，2019,14(1):47-49.

[26] ZHANG SS,SHAO WS,CAO YF,et al. CT and MRI in the diagnosis of intrahepatic peripheral cholangiocarcinoma[J].Hebei Med,2016,22(5):793-794.(in Chinese)张松山，邵文尚，曹永峰，等．CT及MRI对肝内周围型胆管癌综合诊断研究[J]．河北医学，2016,22(5):793-794.

[27] WEI DW. The value of spiral CT and MRI in the diagnosis of intrahepatic cholangiocarcinoma[J]. Imaging Technol,2019,31(1):4-6.(in Chinese)魏定伟．螺旋CT和MRI诊断肝内胆管细胞癌的运用价值研究[J]．影像技术，2019,31(1):4-6.

[28] STUL KE,TISE ML,ALI Z,et al. Acuracy and reliability of measurements obtained from computed tomography 3D volume rendered images[J]. Forensic Sci Int,2014,238:133-140.

[29] BGIN A,MARTEL G,LAPOINTE R,et al. Accuracy of preoperative automatic measurement of the liver volume by CTscan combined to a 3D virtual surgical planning software(3DVSP)[J]. Surg Endosc,2014,28(12):3408-3412.

[30] LI PP,WANG ZH,HUANG G,et al. Application of liver three-dimensional visualization technologies in the treatment planning of hepatic malignant tumor[J]. Chin J Surg,2017,55(12):916-922.(in Chinese)李鹏鹏，王志恒，黄罡，等．肝脏三维可视化技术在肝脏恶性肿瘤治疗规划中的应用研究[J]．中华外科杂志，2017,55(12):916-922.

[31] MALAGUARNERA G,PALADINA I,GIORDANO M,et al. Serum markers of intrahepatic cholangiocarcinoma[J]. Dis Markers,2013,34(4):219-228.

[32] INCE AT,YILDIZ K,BAYSAL B,et al. Roles of serum and biliary CEA,CA19-9,VEGFR3,and TAC in differentiating between malignant and benign biliary obstructions[J]. Turk J Gastroenterol,2014,25(2):162-169.

[33] MARUBASHI S,GOTOH K,TAKAHASHI H,et al. Prediction of the postoperative prognosis of intrahepatic cholangiocarcinoma(ICC):Importance of preoperatively-determined anatomic invasion level and number of tumors[J]. Dig Dis Sci,2014,59(1):201-213.

[34] ZENG X,TAO H. Diagnostic and prognostic serum marker of cholangiocarcinoma(Review)[J]. Oncol Lett,2015,9(1):3-8.

[35] ZHANG QF,LI YZ,LI JX. Diagnosis value of serum CA199,CA242 and CA724 in malignant tumors of digestive system[J]. J Shanxi Med Univ,2007,38(5):430-432.(in Chinese)张启芳，李运泽，李俊喜．血清CA199、CA242和CA724含量对消化系恶性肿瘤的诊断价值[J]．山西医科大学学报，2007,38(5):430-432.

[36] MA WH. Diagnostic value of combined detection of serum CA199 and CEA in the diagnosis of cholangiocarcinoma[J/CD]. J Clin Med,2016,3(3):577-578.(in Chinese)马婉红．血清CA199和CEA联合检测对胆管癌的诊断价值分析[J/CD]．临床医药文献电子杂志，2016,3(3):577-578.

[37] SHEN F,WANG K,YAN ZL,et al. Clinical efficacy and prognostic factors of liver resection for intrahepatic cholangiocarcinoma in 1370 patients[J]. Chin J Dig Surg,2016,15(4):319-328.(in Chinese)沈锋，王葵，阎振林，等．1370例肝内胆管细胞癌肝切除术的疗效及预后因素分析[J]．中华消化外科杂志，2016,15(4):319-328.

[38] DENG YW,ZHONG RH,XIE XY,et al. The clinical value of serum CA19-9 and CA125 in diagnosing of cholangiocarcinoma[J]. Lingnan J Emerg Med,2016,21(3):251-252.(in Chinese)邓雅文，钟日辉，谢晓英，等．血清肿瘤标志物CA19-9和CA125在胆管癌诊断中的价值[J]．岭南急诊医学杂志，2016,21(3):251-252.

[39] ZHANG GB,XU JH. Application of serum CA19-9,CA125and CEA in diagnosis of serum AFP negative patients with intrahepatic cholangiocarcinoma[J]. J Prac Hepatol,2017,20(6):740-743.(in Chinese)张国柄，徐江海．联合CA19-9、CA125和CEA检测在AFP阴性的ICC鉴别诊断中的应用价值[J]．实用肝脏病杂志，2017,20(6):740-743.

[40] NISHIJIMA TF,MUSS HB,SHACHAR SS,et al. Prognostic value of lymphocyte-to-monocyte ratio in patients with solid tumors:A systematic review and meta-analysis[J]. Cancer Treat Rev,2015,41(10):971-978.

[41] CHEN YQ,TIAN Q,GONG J,et al. Diagnostic value of neutrophil/lymphocyte ratio combined with CA19-9 for intrahepatic cholangiocarcinoma[J/CD]. Chin J Hepat Surg:Electronic Edition,2019,8(4):358-361.(in Chinese)陈亚琼，田琪，龚娇，等．中性粒细胞/淋巴细胞比值联合CA19-9对肝内胆管癌的诊断价值[J/CD]．中华肝脏外科手术学电子杂志，2019,8(4):358-361.

[42] CHEN YJ,SHANG CZ. Diagnosis and management of intrahepatic cholangiocarcinoma[J]. Chin J Pract Surg,2015,35(1):43-45.(in Chinese)陈亚进，商昌珍．肝内胆管细胞癌诊治策略[J]．中国实用外科杂志，2015,35(1):43-45.

[43] LI YL. Pathology(8th Edition)[M]. Beijing:People’s Health Press,2013:284.(in Chinese)李玉林．病理学(第八版)[M]．北京:人民卫生出版社，2013:284.

[44] LI XP,LIU SL,JIANG B. Progress of molecular profiling of intrahepatic cholangiocarcinoma[J]. Chin J Gen Surg,2019,28(2):219-226.(in Chinese)李雪鹏，刘苏来，蒋波．肝内胆管癌分子水平研究进展[J]．中国普通外科杂志，2019,28(2):219-226.

[45] FANG F,SONG TQ. Research progress associated with microRNAs in hepatocellular carcinoma[J]. Chin J Gen Surg,2018,27(7):899-909.(in Chinese)房锋，宋天强．微小RNA在肝细胞癌中的相关研究进展[J]．中国普通外科杂志，2018,27(7):899-909.

[46] WONG CM,TSANG FH,NG IO. Non-coding RNAs in hepatocellular carcinoma:Molecular functions and pathological implications[J]. Nat Rev Gastroenterol Hepatol,2018,15(3):137-151.

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