范衛君 吳沛宏 張亮 黃金華 張福君 顧仰葵 趙明 黃祥龍 郭昌宇
【摘要】 目的 探討Ⅲ、Ⅳ型肝門區膽管腺癌綜合介入治療的價值。方法 21 例經病理證實
為肝門區膽管腺癌伴梗阻性黃疸的病例, CT、MR 胰膽管成像、經皮經肝膽系造影術將其分為Ⅲ、Ⅳ
型, 采用內外引流術、多極射頻消融術、膽管內支架置入術及動脈化療灌注術序貫性治療。結果 所
有腫瘤射頻消融治療1 個月后CT 值明顯下降, 13 個病灶縮小約30%, 4 個病灶縮小約20% , 4 個病
灶大小未變; 6 個月后均有縮小, 縮小最顯著者為60% 左右, 21 個病灶平均縮小37% 。有17 例在射
頻消融治療1 個月后直接膽紅素和間接膽紅素恢復到正常水平, 6 個月后復查全部正常。隨診時間
最長的為24 個月, 最短9 個月, 近期平均生存期14 個月。結論 綜合介入治療是Ⅲ、Ⅳ型肝門區膽
管腺癌安全有效的治療方法。
【關鍵詞】 膽管癌; 射頻消融術; 支架; 放射學, 介入性
Interventional ther apy of hilar cholangiocar cinoma in type Ⅲ a nd Ⅳ FAN Wei-jun* , WU Peihong,
ZHANG Liang, HUANG J in-hua, ZHANG Fu-jun, GU Yang-kui, ZHAO Ming, HUANG Xiang-long,
GUO Chang-yu. * State Key Laboratory of Oncology in Southern China; Department of Radiology, Cancer
Center, Sun Yat-Sen University, Guangzhou 510060 , China
Corresponding author: WU Pei-hong, Email : JRKZL@gzsums. edu. cn
【Abstr act 】 Objective To explore the role of synthetic interventional therapy for hilar
cholangiocarcinoma in type Ⅲ and Ⅳ . Met hods Twenty-one patients with obstructive cholestasis were
pathological confirmed as cholangioadenocarcinoma, and they were classified as type Ⅲ and Ⅳ
cholangioadenocarcinoma by CT, MRCP, and percutaneous transhepatic cholangiography. Percutaneous
transhepatic cholangiography with internal and external drainage ( PTCD) , multipolar radiofrequency ( RF)
ablation, biliary stent endoprosthesis, and interventional adjuvant chemotherapy were applied sequentially.
Results All masses presented with density diminution in CT one month after RF ablation, in which
13 masses had about 30% reduction in size, 4 masses had about 20% reduction in size, and 4 masses
remained unchanged. All the masses presented with size reduction with an average of 37% in follow-up CT
after 6 months, and the most remarkable size reduction was 60% . The direct and indirect bilirubin levels
prompt returned to normal range in 17 cases one month after synthetic interventional therapy and returned to
normal range in all cases 6 months later. All patients survived with the follow-up period ranging from 9 to
24 months, with the mean survival time of 14 months. Conclusion Synthetic interventional therapy is a
micro-invasive and effective treatment for type Ⅲ and Ⅳ cholangiocarcinoma.
【Key wor ds】 Cholangiocarcinoma; Radiofrequency ablation; Stents; Radiology, interventional

Ⅲ 、Ⅳ 型肝門區膽管腺癌的介入治療.rar