关键词: 胆管癌, 浅表扩散, 弥漫浸润, 胆管乳头状癌, 肝胰十二指肠切除术

Abstract:

Clinicopathological features and surgical treatment of diffuse cholangiocarcinoma        WU Zhi-yong, Department of Gastrointestinal Surgery，Ren Ji Hospital，School of Medicine，Shanghai Jiao Tong University, Shanghai 200127, China
Abstract  Cholangiocarcinoma has been classified as intrahepatic, perihilar, distal and diffuse. Diffuse cholangiocarcinoma exhibits an extensive ductal spread invading from the hepatic hilus to the lower bile duct, which has two types, namely the superficial spreading and diffuse infiltrating type. Superficial spreading cholangiocarcinoma is defined as mucosal extension of more than 20mm from the main lesion, which is mostly observed in papillary carcinoma or other well differentiated adenocarcinomas of the bile duct. Superficial spreading cholangiocarcinoma is with low malignancy and comparatively good prognosis. Diffuse infiltrating cholangiocarcinoma demonstrates that invading of the tumor involves whole extrahepatic bile duct, whose pathological staging is often late and the prognosis is poor. The gross type of cholangiocarcinoma and the invasive extent of tumor in most cases can be accurately evaluated by MRI，Multidetector Row CT（MDCT）and choledochoscope, etc. It’s especially important to evaluate the extension of the mucosa in the superficial spreading cholangiocarcinoma, which will help the surgeons to design a precise surgery. Most of the patients suffered from diffuse cholangiocarcinoma need to undergo hepatopancreatoduodenectomy including major liver resection. To prevent from postoperative liver failure and  improve surgical safety，it is necessary that the most patients receive biliary drainage and portal vein embolization before the operation.

Key words: cholangiocarcinoma, superficial spreading, diffuse infiltrating, papillary carcinoma of the bile duct, hepatopancreatoduodenectomy