小结
定义
病史和体格检查
关键诊断因素
- painless jaundice
- weight loss
- abdominal pain
其他诊断因素
- pruritus
- triad of fever, jaundice, and right upper quadrant pain
- palpable gallbladder
- hepatomegaly
- dark urine
- pale stools
- asymptomatic
危险因素
- age >50 years
- cholangitis
- choledocholithiasis
- cholecystolithiasis
- other structural disorders of the biliary tract
- ulcerative colitis (UC)
- primary sclerosing cholangitis (PSC)
- nonspecific cirrhosis
- alcoholic liver disease
- liver fluke infection
- chronic typhoid carrier
- hepatitis C virus (HCV)
- HIV
- hepatitis B virus (HBV)
- exposure to thorium dioxide
- diabetes
- cigarette smoking
- exposure to toxins/medications
- male sex
诊断性检查
首要检查
- serum bilirubin
- serum alkaline phosphatase
- serum gamma-GT
- serum aminotransferase
- serum prothrombin time
- serum CA 19-9
- serum carcinoembryonic antigen (CEA)
- serum CA-125
- abdominal ultrasound
- abdominal CT
- abdominal MRI
需考虑的检查
- endoscopic ultrasound (EUS)
- MR angiography
- ERCP
- MRCP
- percutaneous transhepatic catheterization (PTC)
- positron emission tomography (PET)
- Immunostaining
新兴检查
- optical coherence tomography (OCT)
- peroral cholangioscopy
- duodenoscope-assisted cholangioscopy
治疗流程
resectable disease
unresectable disease
撰稿人
作者
N. Joseph Espat, MD, MS, FACS
Chairman of Surgery
Professor
Director Cancer Center
Department of Surgery
Roger Williams Medical Center
Boston University School of Medicine
Providence
RI
利益声明
NJE declares he has no competing interests.
Ponnandai Somasundar, MD, MPH, FACS
Associate Professor and Chief of Surgical Oncology
Department of Surgery
Roger Williams Medical Center
Boston University School of Medicine
Providence
RI
利益声明
PS declares that he has no competing interests.
鸣谢
We would like to acknowledge our Gastroenterology expert panel member, Dr Brooks Cash, for his contribution to this topic.
利益声明
BC declares that he has no competing interests.
同行评议者
Kevin Watkins, MD
Assistant Professor
Department of Surgery
Health Science Center
SUNY
Stony Brook
NY
利益声明
KW declares that he has no competing interests.
Savio Reddymasu, MD
GI Fellow
Department of Medicine
Center for Gastrointestinal Motility
Division of Gastroenterology and Hepatology
University of Kansas Medical Center
Kansas City
KS
利益声明
SR declares that he has no competing interests.
Satvinder Mudan, MBBS, BSc, MD, FRCS
Consultant in Surgical Oncology
The Royal Marsden Hospital
London
UK
利益声明
SM declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Bridgewater J, Galle PR, Khan SA, et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol. 2014;60:1268-1289.全文 摘要
Bowlus CL, Arrivé L, Bergquist A, et al. AASLD practice guidance on primary sclerosing cholangitis and cholangiocarcinoma. Hepatology. 2023 Feb 1;77(2):659-702.全文 摘要
Rushbrook SM, Kendall TJ, Zen Y, et al. British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma. Gut. 2023 Dec 7;73(1):16-46.全文 摘要
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: biliary tract cancers [internet publication].全文
Shroff RT, Kennedy EB, Bachini M, et al. Adjuvant Therapy for Resected Biliary Tract Cancer: ASCO Clinical Practice Guideline. J Clin Oncol. 2019 Apr 20;37(12):1015-1027.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Hepatocellular carcinoma (HCC)
- Ampullary carcinoma
- Pancreatic carcinoma
更多 鉴别诊断指南
- NCCN clinical practice guidelines in oncology: biliary tract cancers
- ACR-ABS-ACNM-ARS-SIR-SNMMI practice parameter for radioembolization of liver malignancies
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