Wu Y, Johlin FC, Rayhill SC, Jensen CS, Xie J, Cohen MB, Mitros FA.
外科，阿肯色大学医学研究院，小石城，阿肯色州 72205，美国

这项回顾性研究重新探讨了我们在监测和早期发现胆管癌（CC）方面的经验，以及采用整块肝切除--胰十二指肠切除，行原位肝移植（OLT-Whipple）达到彻底根治原发性硬化性胆管炎（PSC）并发早期肝门胆管癌方面的经验。对无症状的PSC患者，使用超声内镜和内窥镜逆行胰胆管造影术（ERCP）进行监测和细胞学评估。对确诊的肝门胆管癌患者采用体外放射疗法、病变部位近程放射疗法和OLT-Whipple疗法进行联合治疗。

1988年至2001年期间，我们根据监测方案对119名PSC患者中的42名患者进行了跟踪随访。8名患者被查出患有CC，其中6名接受了OLT-Whipple。在这6名患者中，4例为CC I期，2例为CC II期。6名OLT-Whipple患者均采用体外放射疗法和近程放射疗法进行联合治疗。从诊断到开展OLT-Whipple的平均时间为144天。1名患者在移植术后55个月时因其他原因死亡，该患者没有出现癌症复发，而其他5名患者则分别在术后5.7年、7.0年、8.7年、8.8年和10.1年内都没有出现复发状况。

总之对PSC患者来说，胆管内皮细胞学监测和胆管内超声内镜检查能够早期发现CC。使用外放疗和病变部位近程放疗联合OLT-Whipple疗法整块移除胆道上皮能够为患者带来长期无瘤生存。所有的患者都较好的耐受了这种扩大的手术，而且术后和康复期的生活质量也较好。这项研究结果支持对PSC并发早期肝门部胆管癌患者施行OLT-Whipple进行完整胆道系统全切除的设想。

Liver Transpl. 2008 Mar;14(3):279-86. Links

Long-term, tumor-free survival after radiotherapy combining hepatectomy-Whipple en bloc and orthotopic liver transplantation for early-stage hilar cholangiocarcinoma

Wu Y, Johlin FC, Rayhill SC, Jensen CS, Xie J, Cohen MB, Mitros FA.
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.

This retrospective study reviews our experience in surveillance and early detection of cholangiocarcinoma (CC) and in using en bloc total hepatectomy-pancreaticoduodenectomy-orthotopic liver transplantation (OLT-Whipple) to achieve complete eradication of early-stage CC complicating primary sclerosing cholangitis (PSC). Asymptomatic PSC patients underwent surveillance using endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) with multilevel brushings for cytological evaluation. Patients diagnosed with CC were treated with combined extra-beam radiotherapy, lesion-focused brachytherapy, and OLT-Whipple.

Between 1988 and 2001, 42 of 119 PSC patients were followed according to the surveillance protocol. CC was detected in 8 patients, 6 of whom underwent OLT-Whipple. Of those 6 patients, 4 had stage I CC, and 2 had stage II CC. All 6 OLT-Whipple patients received combined external-beam and brachytherapy radiotherapy. The median time from diagnosis to OLT-Whipple was 144 days. One patient died 55 months post-transplant of an unrelated cause, without tumor recurrence. The other 5 are well without recurrence at 5.7, 7.0, 8.7, 8.8, and 10.1 years.

In conclusion, for patients with PSC, ERCP surveillance cytology and intralumenal endoscopic ultrasound examination allow for early detection of CC. Broad and lesion-focused radiotherapy combined with OLT-Whipple to remove the biliary epithelium en bloc offers promising long-term, tumor-free survival. All patients tolerated this extensive surgery well with good quality of life following surgery and recovery. These findings support consideration of the complete excision of an intact biliary tree via OLT-Whipple in patients with early-stage hilar CC complicating PSC.

Liver Transpl. 2008 Mar;14(3):279-86. Links

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