胆管细胞癌.ppt

Case Discussion Abdominal Group 2013.3.14 History Male,62Y Complaint: abdominal discomfort,anorexia and weight loss for 9 months Laboratory examination:ALP,ALT,AST↑ d380.jpg Final Diagnosis Cholangiocellular carcinoma (CCC) 手术记录 术中探查见腹腔内少量腹水约100ml，淡黄色，清亮，肝左叶可见一约8cm×6cm肿物，左半肝表面多发转移灶，肝十二指肠韧带、肠系膜根部多发肿大淋巴结。游离肝十二指肠韧带，将肝十二指肠韧带骨骼化，分离出肝左右动脉、门静脉左右肝支，左内叶脏面肝转移灶累及肝门部，肝总管左右分支解剖困难，将胆总管切开探查胆道，提示右肝管通畅，左侧胆道闭塞，决定切肝过程中处理胆道。决定行左半肝切除+胆囊切除术+胆肠吻合术。 分别结扎切断左肝动脉、门静脉左支。分离切断镰状、左侧冠状韧带、左三角韧带。解剖胆囊三角，游离胆囊管，距胆总管约0.5cm处钳夹、切断胆囊管，近端双重结扎，远端4#丝线结扎，游离胆囊动脉，钳夹、切断动脉，近远端分别结扎，向右上提起胆囊，以电刀自胆囊床剥离胆囊。将肝左叶向外托出，电刀于肝脏表面预定切除线切开肝包膜，超吸刀分开肝实质，所遇血管、胆管血管钳钳夹、切断、结扎或钛夹夹闭，创面渗血双极电凝止血。在肝门处，保护肝右动脉，离断右肝管，确切处理肝左静脉，将肝II、III、IV段完整切除。 Pathological Result Moderately differentiated CCC Definition CCC is a malignant tumour that arises from intra-hepatic biliary epithelium,mostly from peripheral bile duct,excluding cholangiocarcinnoma（CC） which arises from left or right hepatic duct or common bile duct. Background The second most prevalent primary liver cancer(5％~15％) Average onset age:50~60Y Male female ratio:1.6~2.9:1 5-year survival rate:7％ Risk Factor Primary sclerosing cholangitis(PSC) Clonorchiasis Intra or extra-hepatic calculus Caroli disease Obesity Histologic classification Adenocarcinoma Clear cell adenocarcinoma Mucinous carcinoma Signet ring cell carcinoma Squamous cell carcinoma Adenosquamous carcinoma Small cell carcinoma Undifferentiated carcinoma General Classification Intrahepatic CCC peripheral (10%) hilar (25%) Extrahepatic CCC (65%) Clinical feature Intrahepatic CCC presents as a large mass and does not cause clinical symptoms in early stage. Extrahepatic CCC is usually small at the time of presentation because the bile ducts are occluded in early stage and patients present with jaundice. Plain CT Single Low density Quasi-circular or irregular Enhanced CT Gradually concentric increased Delayed en