胆管癌姑息治疗的研究进展_王荇

210029。。、、、、。。Ｒ735．8A1001－5256201605－1022－04ＲesearchadvancesinpalliativetreatmentofcholangiocarcinomaWANGXingLIXiangcheng．TheFirstAffiliatedHospitalofNanjingMedicalUniversityNanjing210029ChinaAbstractAlthoughradicalresectionistheonlymethodtocurecholangiocarcinomamostpatientsareintheadvancedstageatthetimeofdiagnosisandmissthebesttimeforsurgery．Thepalliativetreatmentfocusingonbiliarydrainagereconstructioncanimprovepatients'qualityoflifeandprolongsurvivaltime．Thisarticleintroducesthelatestadvancesinpalliativetreatmentforcholangiocarcinomainrecentyears．Pa-tientscanbenefitfromthetreatmentmethodssuchasbiliarystentingandpalliativesurgery．Localandsystemicadjuvanttherapiesarealsoindispensiblesuchasradiotherapychemotherapyphotodynamictherapyandimmunotherapybuttheirtherapeuticeffectsawaitfurtherinvestigation．Withthecontinuousdevelopmentofbasicresearchandmedicaltechniquesthetraditionaltherapeuticmethodswillbecon-stantlyimproved．Thenewtherapeuticmethodstargetingthepathogenesisofcholangiocarcinomawillalsoplayanimportantroleandbringbenefitstothepatients．Keywordsbileductneoplasmspalliativecarestentsradiotherapydrugtherapyreviewdoi10．3969/j．issn．1001－5256．2016．05．0512016－02－042016－02－26。1989－。[e-mail]。、1。、、350%40%10%2。Ｒ03。、。。、。14。Smith595943%vs14%P=0．0111%vs29%P=0．0220dvs26dP=0.001。1．1endoscopicretrogradecholan-giopancreatographyEＲCPpercutaneoustranshepaticcholangiographyPTC。24EＲCPPTCEＲCP。Ⅰ、Ⅱ、ⅢPTCⅣPTC。PTC。1．2、。1988Deviere668220132520165JClinHepatolVol．32No．5May．2016176dvs119d。。dePalma7157、A、BA。50%8。2011Hwang9“Y”30“Y”100%38．5%。1．3。、1011。2007MetaMoss127244P＜0．01。Ｒaju135．56vs1．86P＜0．0001。1．4。Isayama14MetaSaleem15。。EＲCP。2、EＲCPpercutaneoustranshepat-iccholangialdrainagePTCDendoscopicultra-soundEUSPTCD。EUS。EUS“”EUSEＲCPEUS“”16。“EUS”“EUS”17。。3、、18。44．1radiofrequencyablationＲFA。Steel1922ＲFA30d100%。ＲFA20ＲFA。4．2transcatheterarterialchemoembo-lisationTACETACE。Park2115521TACE1。TACE30dTACE12．2vs3．3P＜0．01。、、TACETACE22。4．3photodynamictherapyPDT、、。23。PDT。Ortner24392+PDT493dvs98dP＜0．01。25PDTPDT。3201．PDTPDT。5。externalbeamradiotherapyEBＲT。EBＲT。2090。、。Isayama2664、。Gerhards279124vs8。。。Zhu28、。、PDT、TACE。6。5－α、C。2010Valle29Ⅲ410、8．285P＜0．00111．78．181．4%vs71．8%P=0．049。。、。7。。epidermalgrowthfactorreceptorEGFＲvascularendothelialgrowthfactorVEGF30。EGFＲ———VEGF———。+TWilmsWilms'tumorgeneWT1mucin1MUC131。———、、EＲBB2IPmutation－specificCD4+T32－33ⅠⅡ。。。。。PDT+。。。1PAＲODIAFISHEＲDGIOVANNINIMetal．Endoscopicman-agementofhilarcholangiocarcinomaJ．NatＲevGastroenterolHepatol201292105－112．2ＲAZUMILAVANGOＲESGJ．CholangiocarcinomaJ．Lancet201438399352168－2179．3SHAＲIFFMIKHANSAWESTABYD．Thepalliationofcholangio-carcinomaJ．CurrOpinSupportPalliatCare201372168－174．4BLECHACZBGOＲESGJ．CholangiocarcinomaadvancesinpathogenesisdiagnosisandtreatmentJ．Hepatology2008481308－321．5SMITHACDOWSETTJFＲUSSELLＲCetal．Ｒandomisedtrialofendoscopicstentingversussurgicalbypassinmalignantlowbileductob-structionJ．Lancet199434489381655－1660．6DEVIEＲEJBAIZEMDETJetal．Long－termfollow－upof420132520165JClinHepatolVol．32No．5May．2016patientswithhilarmalignantstricturetreatedbyendoscopicinternalbiliarydrainageJ．GastrointestEndosc198834295－101．7dePALMAGDGALLOＲOGSICILIANOSetal．Unilateralversusbilateralendoscopichepaticductdrainageinpatientswithmalignanthilarbiliaryobstructionresultsofaprospectiveran-domizedandcontrolledstudyJ．GastrointestEndosc2001536547－553．8ＲEＲKNIMITＲＲANGSUWATCHAＲAKONPＲATANACHUEKTetal．Asia－Pacificconsensusrecommendationsforendoscopicandinter-ventionalmanagementofhilarcholangiocarcinomaJ．JGastroenterolHepatol2013284593－607．9HWANGJCKIMJHLIMSGetal．Y－shapedendoscopicbi-lateralmetalstentplacementformalignanthilarbiliaryobstructionprospectivelong－termstudyJ．ScandJGastroenterol2011463326－332．10SINGHALDvanGULIkTMGOUMADJ．PalliativemanagementofhilarcholangiocarcinomaJ．SurgOncol200514259－74．11FＲEEMANMLSIELAFFTD．Amodernapproachtomalignanthi-larbiliaryobstructionJ．ＲevGastroenterolDisord200334187－201．12MOSSACMOＲＲISELEYDENJetal．DothebenefitsofmetalstentsjustifythecostsAsystematicreviewandmeta－analysisoftrialscomparingendoscopicstentsformalignantbiliaryobstructionJ．EurJGastroenterolHepatol200719121119－1124．13ＲAJUＲPJAGANMOHANSＲＲOSSWAetal．Optimumpallia-tionofinoperablehilarcholangiocarcinomacomparativeassessmentoftheefficacyofplasticandself－expandingmetalstentsJ．DigDisSci20115651557－1564．14ISAYAMAHKOMATSUYTSUJINOTetal．Aprospectiverandomisedstudyof‘covered’versus‘uncovered’diamondstentsforthemanagementofdistalmalignantbiliaryobstructionJ．Gut2004535729－734．15SALEEMALEGGETTCLMUＲADMHetal．Meta－analysisofrandomizedtrialscomparingthepatencyofcoveredanduncoveredself－expandablemetalstentsforpalliationofdistalmalignantbileductobstructionJ．GastrointestEndosc2011742321－327．16PAＲKDHSONGTJEUMJetal．EUS－guidedhepaticogastro-stomywithafullycoveredmetalstentasthebiliarydiversiontech-niqueforanoccludedbiliarymetalstentafterafailedEＲCPwithvideosJ．GastrointestEndosc2010712413－419．17YAMAOKBHATIAVMIZUNONetal．InterventionalendoscopicultrasonographyJ．JGastroenterolHepatol2009244509－519．18SHAＲIFFMIKHANSAWESTABYD．Thepalliationofchol