胆管癌外科治疗课件整理

胆管癌外科治疗的奥踐和存在问题的探讨胆管癌外科治疗的奥踐1概Biliaryductcancer/Cholangiocarcinoma定义:发生于肝外胆管(含左右肝管主干至胆总管下端)恶性肿瘤的总称。不包括肝内胆管癌、肝脏胆管细胞癌、胆囊癌、乏特壶腹癌发生部位:上段胆管瘟中段胆管癌下段胆管癌概2争论Figur1:ClaasiseationofChelangieesreinema源于胆管上皮的恶性肿瘤—胆管癌(含肝内、肝外胆管癌侵RepooucecwinpensiontrumPatelT-Choancarcnoma,hacinPactGasl0aL20063134及肝门部胆管)●Intra-hepaticCholangiocarcinomaExtra-hepaticCholangiocarcinoma争论3流行病学资料6os--70sBileductcancer=3,000/yrHighestincidenceineGallBladdercancer=6,goo/yJapan,Israel,andNativeamericansHepatocellularCa=15,ooo/yr●IncreasedintheUSA●M/F=3/2Rightorlefthepaticduct%●Bifurcation=20%USMazenhassanainmd●Proximalcbd=30%手术切除率10%DistalCBD=30%流行病学资料4病因学资料病因未明多病因高危因素胆管结石胆道蛔虫胆管炎癌中华分枝睾吸虫先天性胆管囊状扩张症■→》癌(癌变率达25%~15%)病因学资料5胆管癌治疗与临床指南美国癌症联合会NCCN●欧洲肿瘤医学会EMSO英国肝脏病协会BASL其他NHSHospitalguidline胆管癌治疗与临床指南6CietprehenaiveNCCNGuidelinesVersion2.2012Newark.ExtrahepaticCholangiocarcinomaFRMARYTREATMENTnignotprimiidneghemgradirasion'R→3SurveillaneEXTRA2)CietprehenaiveNCCNGuidelines7clinicalpracticeguidelinesofOncolgy21Pupplamant5:ve5-v692010Biliarycancer:ESMOClinicalPracticeGuidelinesfordiagnosis,treatmentandfollow-upF.Eckel.TBrunner&SJelicOnbehalfoftheESMOGuidelinesWorkingGrouKwwkrnecusaatMnwch,Gman"GraysnareafAaaaOnmgyanEaagyyofOxydChuc/MHosp!.hamadMer/chgSar/oBnstituteorOncologya,B电aSet图inecidenceaparoscopy.UpperandlowerendoscopyhastobeperformeThecrudeincidenceafgallbladderandextrahepaticbiliainpatientswithanisolatedintrahepaticmass.Thestagingiscancer(ICD-10:C23-C24)intheEuropeanUnionis3.2ordingtatheTNM2010systemseratelyfor[Table1),intrhepaticcholangiocarcinomaand-5.4/10000peryearformalesandfemales,respectively.(Table2a).perhilarcholangiocarcinoma(Tabke2b),anddistalge-adjustedmortalityis1.4and1.9/100DO)formalesandcholangiocarcinoma(Tableze)HilarcholangiocarcinomaoLangiocarcinoma(ICD-10.C22isincreasingandmaybeinvolvementofthehepaticductsaccordingtotheBismuth-matedas0,9-1.3and0.4-0.7/100000formalesandales,respectively,as10%r-15%ofprimarylivercanICD-10:C22).Inhigh-riskareasinEurope(southItaly)incidenceisestimatedatupto4.9-7.4and-2.9-4.3/100000treatmentafterincidentalfindingofclinicalpracticeguidelines8GUIDELINESGuidelinesforthediagnosisandtreatmentofcholangiocarcinoma:consensusdocumentBRDavidson,RGoldin,SPPerelMCRosenbergas,MRThurs.HWasanclchalangioarcimaeIheneellBileductadenomaandbiliarypauillomalosiCarali'sdiseasecysticdilatationcrdut,lifctimericE73).cysts(aboutswilltransform.withage)helorethetinaldeciesSmokingincreasedriskinassocitionwithPsC)erethetumourcntheassnlwerIlukes-opIiwvE/urwITweandCNE/Ni3/N2515chronictyphoidcarriarixtokinucaxdrikofallhepatobiliarymalignancvidenceawailable(action2.1.3ContextandintentTheseguidelinesarcinkndcdtobringsomitcneyandasinclusiveofiniEhepatEPlGUIDELINES9ssuedate:July2005NHSNationalInstituteforHealthandClinicalExcellencePhotodynamictherapyforbileductcancerGuidance1.2Treatmentoptionsdependonthestage,size,1Currentevidenceonthesafetyandefficacyofpositionandtypeottumour.Bleductcancerisphotodynamictherapy(PDI)farbileductcancernotusualbydiagnosedbeforethesymptomsofesnotappearadequateforthisproceduretoliarobstructionoccur,bywhichtimethebeusedwithoutspecialarrangementsforcorermaybetooadvancedforcurativesurgiGaandforauditorresearchresection.OptionsforpalliatvetreatmentincludeurgicalbypassofthebileductortheinsertionofancershouldtakethefollowingactionsnformtheclinicalgovernanceleadsintheirTrustshemotherapyandbrachytherapyarestillbeingssuedate:July200510胆管癌外科治疗课件整理11胆管癌外科治疗课件整理12胆管癌外科治疗课件整理13胆管癌外科治疗课件整理14胆管癌外科治疗课件整理15胆管癌外科治疗课件整理16胆管癌外科治疗课件整理17胆管癌外科治疗课件整理18胆管癌外科治疗课件整理19胆管癌外科治疗课件整理20胆管癌外科治疗课件整理21胆管癌外科治疗课件整理22胆管癌外科治疗课件整理23胆管癌外科治疗课件整理24胆管癌外科治疗课件整理25胆管癌外科治疗课件整理26胆管癌外科治疗课件整理27胆管癌外科治疗课件整理28胆管癌外科治疗课件整理29胆管癌外科治疗课件整理30胆管癌外科治疗课件整理31胆管癌外科治疗课件整理32胆管癌外科治疗课件整理33胆管癌外科治疗课件整理34胆管癌外科治疗课件整理35胆管癌外科治疗课件整理36胆管癌外科治疗课件整理37胆管癌外科治疗课件整理38胆管癌外科治疗课件整理39胆管癌外科治疗课件整理40胆管癌外科治疗课件整理41胆管癌外科治疗课件整理42胆管癌外科治疗课件整理43胆管癌外科治疗课件整理44胆管癌外科治疗课件整理45胆管癌外科治疗课件整理46胆管癌外科治疗课件整理47胆管癌外科治疗课件整理48胆管癌外科治疗课件整理49胆管癌外科治疗课件整理50胆管癌外科治疗课件整理51胆管癌外科治疗课件整理52胆管癌外科治疗课件整理53胆管癌外科治疗课件整理54胆管癌外科治疗课件整理55胆管癌外科治疗课件整理56胆管癌外科治疗课件整理57胆管癌外科治疗课件整理58胆管癌外科治疗课件整理59胆管癌外科治疗课件整理60胆管癌外科治疗课件整理61胆管癌外科治疗课件整理62胆管癌外科治疗课件整理63胆管癌外科治疗课件整理64胆管癌外科治疗课件整理65胆管癌外科治疗课件整理66胆管癌外科治疗课件整理67胆管癌外科治疗课件整理68胆管癌外科治疗的奥踐和存在问题的探讨胆管癌外科治疗的奥踐69概Biliaryductcancer/Cholangiocarcinoma定义:发生于肝外胆管(含左右肝管主干至胆总管下端)恶性肿瘤的总称。不包括肝内胆管癌、肝脏胆管细胞癌、胆囊癌、乏特壶腹癌发生部位:上段胆管瘟中段胆管癌下段胆管癌概70争论Figur1:ClaasiseationofChelangieesreinema源于胆管上皮的恶性肿瘤—胆管癌(含肝内、肝外胆管癌侵RepooucecwinpensiontrumPatelT-Choancarcnoma,hacinPactGasl0aL20063134及肝门部胆管)●Intra-hepaticCholangiocarcinomaExtra-hepaticCholangiocarcinoma争论71流行病学资料6os--70sBileductcancer=3,000/yrHighestincidenceineGallBladdercancer=6,goo/yJapan,Israel,andNativeamericansHepatocellularCa=15,ooo/yr●IncreasedintheUSA●M/F=3/2Rightorlefthepaticduct%●Bifurcation=20%USMazenhassanainmd●Proximalcbd=30%手术切除率10%DistalCBD=30%流行病学资料72病因学资料病因未明多病因高危因素胆管结石胆道蛔虫胆管炎癌中华分枝睾吸虫先天性胆管囊状扩张症■→》癌(癌变率达25%~15%)病因学资料73胆管癌治疗与临床指南美国癌症联合会NCCN●欧洲肿瘤医学会EMSO英国肝脏病协会BASL其他NHSHospitalguidline胆管癌治疗与临床指南74CietprehenaiveNCCNGuidelinesVersion2.2012Newark.ExtrahepaticCholangiocarcinomaFRMARYTREATMENTnignotprimiidneghemgradirasion'R→3SurveillaneEXTRA2)CietprehenaiveNCCNGuidelines75clinicalpracticeguidelinesofOncolgy21Pupplamant5:ve5-v692010Biliarycancer:ESMOClinicalPracticeGuidelinesfordiagnosis,treatmentandfollow-upF.Eckel.TBrunner&SJelicOnbehalfoftheESMOGuidelinesWorkingGrouKwwkrnecusaatMnwch,Gman"GraysnareafAaaaOnmgyanEaagyyofOxydChuc/MHosp!.hamadMer/chgSar/oBnstituteorOncologya,B电aSet图inecidenceaparoscopy.UpperandlowerendoscopyhastobeperformeThecrudeincidenceafgallbladderandextrahepaticbiliainpatientswithanisolatedintrahepaticmass.Thestagingiscancer(ICD-10:C23-C24)intheEuropeanUnionis3.2ordingtatheTNM2010systemseratelyfor[Table1),intrhepaticcholangiocarcinomaand-5.4/10000peryearformalesandfemales,respectively.(Table2a).perhilarcholangiocarcinoma(Tabke2b),anddistalge-adjustedmortalityis1.4and1.9/100DO)formalesandcholangiocarcinoma(Tableze)HilarcholangiocarcinomaoLangiocarcinoma(ICD-10.C22isincreasingandmaybeinvolvementofthehepaticductsaccordingtotheBismuth-matedas0,9-1.3and0.4-0.7/100000formalesandales,respectively,as10%r-15%ofprimarylivercanICD-10:C22).Inhigh-riskareasinEurope(southItaly)incidenceisestimatedatupto4.9-7.4and-2.9-4.3/100000treatmentafterincidentalfindingofclinicalpracticeguidelines76GUIDELINESGuidelinesforthediagnosisandtreatmentofcholangiocarcinoma:consensusdocumentBRDavidson,RGoldin,SPPerelMCRosenbergas,MRThurs.HWasanclchalangioarcimaeIheneellBileductadenomaandbiliarypauillomalosiCarali'sdiseasecysticdilatationcrdut,lifctimericE73).cysts(aboutswilltransform.withage)helorethetinaldeciesSmokingincreasedriskinassocitionwithPsC)erethetumourcntheassnlwerIlukes-opIiwvE/urwITweandCNE/Ni3/N2515chronictyphoidcarriarixtokinucaxdrikofallhepatobiliarymalignancvidenceawailable(action2.1.3ContextandintentTheseguidelinesarcinkndcdtobringsomitcneyandasinclusiveofiniEhepatEPlGUIDELINES77ssuedate:July2005NHSNationalInstituteforHealthandClinicalExcellencePhotodynamictherapyforbileductcancerGuidance1.2Treatmentoptionsdependonthestage,size,1Currentevidenceonthesafetyandefficacyofpositionandtypeottumour.Bleductcancerisphotodynamictherapy(PDI)farbileductcancernotusualbydiagnosedbeforethesymptomsofesnotappearadequateforthisproceduretoliarobstructionoccur,bywhichtimethebeusedwithoutspecialarrangementsforcorermaybetooadvancedforcurativesurgiGaandforauditorresearchresection.OptionsforpalliatvetreatmentincludeurgicalbypassofthebileductortheinsertionofancershouldtakethefollowingactionsnformtheclinicalgovernanceleadsintheirTrustshem