肝门部胆管癌的内镜诊疗研究进展

Advances in Endoscopic Diagnosis and Treatment of Hilar Cholangiocarcinoma

摘要: 肝门部胆管癌(hilar cholangiocarcinoma, HCCA)属于一类恶性程度较高、侵袭性显著的肿瘤性疾病，发病率逐年上升，预后较差。由于其解剖位置复杂、早期缺乏特异性症状，临床诊断与治疗面临挑战。近年来，内镜相关技术的不断发展为HCCA的精准诊断与综合治疗提供了新的思路与手段。本文系统综述了HCCA在内镜诊疗方面的最新进展，涵盖内镜逆行胰胆管造影与胆管内超声的协同应用、SpyGlass与国产胆道镜系统的对比、超声内镜引导下细针穿刺抽吸/活检在组织学诊断中的突破、荧光原位杂交等分子病理技术的引入，以及多种内镜下胆道引流和胆管腔内治疗方式的临床实践。在诊断方面，新兴内镜技术显著提高了病灶识别与组织获取的敏感性与准确性；在治疗方面，个体化引流策略和局部腔内治疗手段拓展了HCCA的综合管理路径。未来，随着人工智能、精准介入及影像引导技术的融合，HCCA的内镜诊疗将朝着更微创、更精准、更个体化的方向发展。

Abstract: Hilar cholangiocarcinoma (HCCA) is a highly aggressive malignancy with increasing global incidence and poor prognosis. Due to its anatomically complex location and lack of specific early symptoms, both diagnosis and treatment remain challenging. In recent years, the continuous advancement of endoscopic techniques has provided new strategies for the accurate diagnosis and comprehensive management of HCCA. This review systematically summarizes recent progress in endoscopic diagnosis and therapy for HCCA, including the combined application of ERCP and intraductal ultrasound, comparison between SpyGlass and domestic cholangioscopy systems, breakthroughs in histological diagnosis using EUS-guided fine-needle aspiration/biopsy, the incorporation of molecular techniques such as fluorescence in situ hybridization, and various endoscopic biliary drainage and intraductal therapeutic approaches. In terms of diagnosis, novel endoscopic modalities have significantly improved the sensitivity and accuracy of lesion identification and tissue acquisition. Therapeutically, individualized drainage strategies and local ablative therapies have expanded the treatment landscape for HCCA. With the integration of artificial intelligence, precision interventions, and image-guided technologies, endoscopic diagnosis and treatment of HCCA is expected to move towards a more minimally invasive, accurate, and personalized era.