肝内胆管癌的外科治疗进展

摘要

肝内胆管癌(ICC)是发病率仅次于肝细胞癌的肝脏恶性肿瘤.肝切除术是ICC唯一有效的根治性治疗方式,但手术切除率低,术后极易复发转移.随着对ICC生物学特性和预后规律的深入认识,近年来ICC的外科治疗策略和技术方法有较大进步,远期疗效也有一定程度的改善.ICC准确的临床诊断、R0切除、术中区域性淋巴结清扫、术后有效的辅助治疗,以及复发性ICC的再切除和多学科治疗,是目前提高该病总体疗效的主要途径.对于无法一期切除的ICC,降期治疗可能提供切除的机会.深入开展ICC生物学异质性的研究,探索改善外科治疗或建立新的治疗方法是今后研究的主要方向.%Intrahepatic cholangiocarcinoma(ICC) is a primary liver cancer with its incidence only after hepatocellular carcinoma.Liver resection is currently the only established effective treatment for patients with ICC.However,the resectability of ICC is low and the long-term survival after surgery is far from satisfactory.With the advances in the understanding of the biological characteristics and prognostic characteristics of ICC,surgical strategy and techniques have improved in recent years,and the long-term survival has also been increased.The accurate clinical diagnosis of ICC,R0 resection,routine lymphadenectomy,effective adjuvant therapy after R0 resection,and multidisciplinary treatment including re-hepatectomy for recurrent ICC are important for achieving an optimal outcome.Down-staging management for patients with unresectable ICC may provide a chance of R0 resection in some patients.Further research on the biological heterogeneity of ICC,and the improvement of surgical treatment or the establishment of new treatment methods are the main research directions in the future.