肝门部胆管癌影像分型及治疗策略初探

目的 研究肝门部胆管癌的影像学分型，并探讨其临床价值与治疗方式的关系。材料与方法 男49例，女14例。全部病例均经PTC、CT和／或MRI、B超检查。采用Bismuth-CorletteⅠ－Ⅳ型分型法。结果 Ⅰ型16例，Ⅱ型7例，Ⅲ型14例（Ⅲa型5例；Ⅲb型9例），Ⅳ型26例。13例手术切除，包括Ⅰ型8例，Ⅱ型2例，Ⅲa型1例，Ⅲb型2例，Ⅳ型均未能切除。其中根治性切除5例，姑息性切除8例；非切除组47例，包括胆－肠吻合术20例，内、外引流术23例，金属支架入术4例。CT和或／MRI显示肝动脉和／或门静脉受侵38例，伴肝转移3例，淋巴结转移2例。结论 影像学分型结合CT和／或MRI可为选择治疗方式提供依据。

Management Strategy and Imaging Classification of Hepatic Portal Cholangiocarcinoma

Objective To study the imaging classification of hepatic portalcholangiocarcinoma and its clinical application. Materials and Methods PTC, CT and/or MRI, sonography were performed in 63 patients (49 males and 14 females) with hepatic portal cholangiocarcinoma. The cases were classified with Bismuth-Corlette typing (Ⅰ～Ⅳ type). Results Sixteen cases were classified into type Ⅰ, while 7, 14, and 26 into type Ⅱ, Ⅲ (including 5 of Ⅲa and 9 of Ⅲb) and Ⅳ, respectively. Surgical excision was done in 13 cases with type Ⅰ (n=8), Ⅱ (n=2), Ⅲa (n=1) or Ⅲb (n=2), including radical excision in 5 and palliative excision in 8 cases. All the lesions in type Ⅳ were unresectable. Of 47 cases in non-excision group, cholangio-enterostomy was done in 20, both internal and external biliary drainage in 23 and metallic stent implantation in 4. On CT and/or MRI, hepatic artery and/or portal vein involvement was seen in 38, hepatic metastasis in 3, and lymphadenopathy in 2 cases. Conclusion Imaging classification combined with CT and MRI findings can provide important basis for clinicians to select proper therapeutic plan.