不可切除肝内胆管癌的治疗进展

Progress in Treatment of Unresectable Intrahepatic Cholangiocarcinoma

摘要: 肝内胆管癌(ICC)是胆道癌的一种，具有多种起源：胆管上皮细胞、肝细胞、肝母细胞等；肝内胆管癌是目前第二大常见的原发性肝癌，患者就诊时往往已是晚期，预后较差。近年来，肝内胆管癌的发病率逐年上升，考虑与影像学及相关辅助诊断日渐先进及完善有关。对于ICC患者手术无疑是最佳治疗方案，但由于疾病发现时已然晚期，满足手术条件的少之又少；对于不可切除性肝内胆管癌患者，吉西他滨联合顺铂类药物为其首选化学辅助治疗方案；对于不可切除肝内胆管细胞癌患者而言，拥有越来越多的选择方案：TACE治疗，钇90微球放疗栓塞，微波消融，射频消融，靶向及免疫治疗。ICC在组织学形态和分子表达水平上表现出高度的患者间和肿瘤内异质性，对临床干预造成阻碍。本文就不可切除ICC的治疗方案展开讲解。

Abstract: Intrahepatic cholangiocarcinoma (ICC) is a kind of bile duct cancer, which has many origins: bile duct epithelial cells, hepatocytes, hepatoblasts, etc. Intrahepatic cholangiocarcinoma is the second most common primary liver cancer at present, and patients are often in advanced stage when they see a doctor, with poor prognosis. In recent years, the incidence of intrahepatic cholangiocarcinoma has increased year by year, which is related to the increasingly advanced and perfect imaging and related auxiliary diagnosis. Surgery is undoubtedly the best treatment for ICC patients, but few pa-tients meet the surgical conditions because of the advanced stage of disease discovery. Gemcitabine combined with cisplatin is the first choice for patients with unresectable intrahepatic cholangiocar-cinoma. For patients with unresectable intrahepatic cholangiocarcinoma, there are more and more options: TACE treatment, yttrium 90 microsphere radiotherapy embolization, microwave ablation, radiofrequency ablation, targeted and immunotherapy. ICC shows high heterogeneity between pa-tients and tumors in histological morphology and molecular expression level, which hinders clinical intervention. This article explains the treatment scheme of unresectable ICC.