Ⅲ 、Ⅳ 型肝门区胆管腺癌的介入治疗

范卫君 吴沛宏 张亮 黄金华 张福君 顾仰葵 赵明 黄祥龙 郭昌宇
【摘要】 目的 探讨Ⅲ、Ⅳ型肝门区胆管腺癌综合介入治疗的价值。方法 21 例经病理证实
为肝门区胆管腺癌伴梗阻性黄疸的病例, CT、MR 胰胆管成像、经皮经肝胆系造影术将其分为Ⅲ、Ⅳ
型, 采用内外引流术、多极射频消融术、胆管内支架置入术及动脉化疗灌注术序贯性治疗。结果 所
有肿瘤射频消融治疗1 个月后CT 值明显下降, 13 个病灶缩小约30%, 4 个病灶缩小约20% , 4 个病
灶大小未变; 6 个月后均有缩小, 缩小最显著者为60% 左右, 21 个病灶平均缩小37% 。有17 例在射
频消融治疗1 个月后直接胆红素和间接胆红素恢复到正常水平, 6 个月后复查全部正常。随诊时间
最长的为24 个月, 最短9 个月, 近期平均生存期14 个月。结论 综合介入治疗是Ⅲ、Ⅳ型肝门区胆
管腺癌安全有效的治疗方法。
【关键词】 胆管癌; 射频消融术; 支架; 放射学, 介入性
Interventional ther apy of hilar cholangiocar cinoma in type Ⅲ a nd Ⅳ FAN Wei-jun* , WU Peihong,
ZHANG Liang, HUANG J in-hua, ZHANG Fu-jun, GU Yang-kui, ZHAO Ming, HUANG Xiang-long,
GUO Chang-yu. * State Key Laboratory of Oncology in Southern China; Department of Radiology, Cancer
Center, Sun Yat-Sen University, Guangzhou 510060 , China
Corresponding author: WU Pei-hong, Email : JRKZL@gzsums. edu. cn
【Abstr act 】 Objective To explore the role of synthetic interventional therapy for hilar
cholangiocarcinoma in type Ⅲ and Ⅳ . Met hods Twenty-one patients with obstructive cholestasis were
pathological confirmed as cholangioadenocarcinoma, and they were classified as type Ⅲ and Ⅳ
cholangioadenocarcinoma by CT, MRCP, and percutaneous transhepatic cholangiography. Percutaneous
transhepatic cholangiography with internal and external drainage ( PTCD) , multipolar radiofrequency ( RF)
ablation, biliary stent endoprosthesis, and interventional adjuvant chemotherapy were applied sequentially.
Results All masses presented with density diminution in CT one month after RF ablation, in which
13 masses had about 30% reduction in size, 4 masses had about 20% reduction in size, and 4 masses
remained unchanged. All the masses presented with size reduction with an average of 37% in follow-up CT
after 6 months, and the most remarkable size reduction was 60% . The direct and indirect bilirubin levels
prompt returned to normal range in 17 cases one month after synthetic interventional therapy and returned to
normal range in all cases 6 months later. All patients survived with the follow-up period ranging from 9 to
24 months, with the mean survival time of 14 months. Conclusion Synthetic interventional therapy is a
micro-invasive and effective treatment for type Ⅲ and Ⅳ cholangiocarcinoma.
【Key wor ds】 Cholangiocarcinoma; Radiofrequency ablation; Stents; Radiology, interventional

Ⅲ 、Ⅳ 型肝门区胆管腺癌的介入治疗.rar