肝门部胆管癌治疗进展培训课件.ppt

目录EtiologyofHilarCholangiocarcinomaPSC与胆道系统肿瘤RolesofClonorchisEndemicusInfectionasRiskFactorforCC华支睾吸虫是肝门胆管癌的易感因素AhistoryofeatingrawfreshwaterfishandapositiveserologicresultforC.sinensisweresignificantlyassociatedwiththedevelopmentofCCTheWaysofMetastasis转移途径HilarCholangiocarcinoma—Diagnosis肝门胆管癌诊断方法Diagnosis-CTCT诊断Diagnosis-MRIMRI诊断MRCPTheRoleofHistologicalDiagnosis组织学诊断的作用DistributionofHilarCholangiocarcinoma肝门胆管癌分布PathologyofHilarCholangiocarcinoma病理分型名称Bismuth-Corlette分型IGazzaniga分期（T分期法）T3:Tumorsoccludingthecommonhepaticductorthesecondarybileduct,andinvolvingthehepaticportalveinoffside,orwiththecontralateralliveratrophy,orinvolvingthemainhepaticportalvein肿瘤侵及肝管汇合部并且双侧都侵袭至二级胆管或肿瘤单侧侵袭至二级胆管同时合并对侧门静脉受累；或肿瘤单侧侵袭至二级胆管同时合并对侧肝叶萎缩；或肿瘤累及门静脉主干或者双侧门静脉均受累AJCC分期PrognosticFactors预后因素Prognosticfactor:preoperativeserumCA19-9levels1、术前CA19-9水平是肝门胆管癌术后的独立预后因素RochaFG,etal.JHepatobiliaryPancreatSci,2010Prognosticfactor:thevolumeofremnantliver3、准确的术前定位与剩余肝体积影响预后Thevolumeofremnantliverandprognosis剩余肝体积与预后关系LiuF,etal.DigDisSci,2010Preoperativebiliarydecompressioninpatientwithcholangiocarcinoma肝门胆管癌患者术前胆道减压PreoperativebiliarydrainageoftheFLR(futureliverremnant)appearstoimproveoutcomeifthepredictedvolumeis<30%.However,inpatientswithFLR>or=30%,preoperativebiliarydrainagedoesnotappeartoimproveperioperativeoutcome这篇meta分析包括10个研究711位肝门胆管癌，其中442位合并黄疸患者进行了术前胆管引流，233位黄疸患者未进行术前引流，临床数据分析不支持肝门胆管癌合并黄疸患者能从引流中获益Advantagesanddisadvantagesofdifferentmethodsofbiledrainage不同胆管引流方法的优劣Prognosticfactor:histologicalclassification5、组织学分型影响预后Prognosticfactor:Tumordepth6、肿瘤浸润深度及长期预后Prognosticfactor:typeofliverresection7、肝切除类型与预后关系InvasionofIVCindicatespoorprognosis8、下腔静脉侵犯预示不良预后肝门胆管癌外科治疗方法Patientsresected(solidline)hadbetteroverall5-yearsurvival(35%)thanpatientsthatwerenotresected.Nounresectedpatient(dottedline)survivedto24monthsSurgicalresectionisthebesttreatmentforhilarcholangiocarcinomaPrecisesurgicalresectionforhilarcholangiocarcinoma肝门胆管癌的外科治疗肝门胆管癌切除的根治程度R0resectionsignificantlyimprovedsurvivalrate1、R0切除能显著