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| 1 | 弥漫型胆管癌临床病理学特征及外科治疗显示文摘胆管癌分为肝内、肝门、远端及弥漫型四种。弥漫型胆管癌是指肿瘤浸润较广泛或浸润全部肝外胆管,有两种类型,即浅表扩散性和弥漫浸润性。浅表扩散是指胆管癌从主瘤灶沿黏膜扩散>20 mm者,常见于胆管乳头状癌及其他分化好的腺癌中,恶性程度较低,预后较好。弥漫浸润是指胆管癌累及从肝门至远端的全部肝外胆管,病理学分期晚,预后差。应用MRI、多层螺旋CT以及胆管镜等检查,大多数病人可准确诊断胆管癌的大体类型及胆管累及的程度,特别是在浅表扩散性胆管癌中明确胆管黏膜累及的范围至关重要,这有助于设计精准的手术方案。弥漫型胆管癌需行包括大范围肝切除的肝胰十二指肠切除术者,术前大多需行胆道引流和门静脉栓塞,以增加手术的安全性及防止术后发生肝功能衰竭。 | 吴志勇 | 2016 | 中国实用外科杂志2016，36，1： | 4 |
| 2 | 新一代SpyGlass单人操作胆道镜系统诊疗不明性质胆道狭窄的研究进展显示文摘目的 胆道狭窄病因复杂,其良恶性的早期诊断对患者的治疗及预后有重要的指导意义。近年来胆道镜技术不断发展,新一代的SpyGlass单人操作经口胆道镜具有视觉诊断和直视下针对活检的优势,可提高性质不明胆道狭窄的诊断准确性。此外,SpyGlass可通过自然通道解决部分胆道狭窄的问题,降低了外科手术需求。SpyGlass在实际应用当中不可避免会出现相关术后并发症和使用局限性。目前国内对SpyGlass系统诊治胆道狭窄的认知方面尚无统一共识,我们回顾了SpyGlass的最新进展,进一步阐明了SpyGlass的诊断性能、治疗干预、并发症及其局限性,就新一代SpyGlass系统对胆道狭窄的诊疗进展作一综述。 | 陈康迪 殷霖霖 缪林 季国忠 张秀华 | 2022 | 现代消化及介入诊疗2022，27，3： | 4 |
| 3 | Intraductal papillary neoplasm of the bile duct in liver cirrhosis with hepatocellular carcinoma显示文摘A case of intraductal papillary neoplasm of the bile duct (IPNB) arising in a patient with hepatitis B-related liver cirrhosis with hepatocellular carcinoma (HCC) is reported. A 76-year-old man was admitted to our hospital with recurrent HCC. Laboratory data showed that levels of carcinoembryonic antigen and carbohydrate antigen 19-9 were elevated. He died of progressive hepatic failure. At autopsy,in addition to HCCs,an intraductal papillary proliferation of malignant cholangiocytes with fibrovascular cores was found in the dilated large bile ducts in the left lobe,and this papillary carcinoma was associated with an invasive mucinous carcinoma (invasive IPNB). Interestingly,extensive intraductal spread of the cholangiocarcinoma was found from the reactive bile ductular level to the interlobular bile ducts and septal bile ducts and to the large bile ducts in the left lobe. Neural cell adhesion molecule,a hepatic progenitor cell marker,was detected in IPNB cells. It seems possible in this case that hepatic progenitor cells located in reactive bile ductules in liver cirrhosis may have been responsible for the development of the cholangiocarcinoma and HCC,and that the former could have spread in the intrahepatic bile ducts and eventually formed grossly visible IPNB. | Jing Xu Yasunori Sato Kenichi Harada Norihide Yoneda Yasuni Nakanuma Teruyuki Ueda Atsushi Kawashima Akishi Ooi | 2011 | World Journal of Gastroenterology2011，17，14： | 4 |
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