小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 无痛性黄疸
- 体重减轻
- 腹痛
其他诊断因素
- 瘙痒
- 高热，黄疸和右上腹痛
- 胆囊可触及
- 肝肿大
- 小便黄赤
- 陶土样大便
- 无症状
危险因素
- 年龄＞50 岁
- 胆管炎
- 胆总管结石
- 胆囊结石
- 其他胆道构造异常的疾病
- 溃疡性结肠炎 (UC)
- 原发性硬化性胆管炎 (primary sclerosing cholangitis, PSC)
- 非典型性硬化
- 酒精性肝病
- 肝吸虫感染
- 慢性伤寒带菌
- 丙型肝炎
- HIV
- 乙型肝炎（HBV）
- 氧化钍暴露
- 糖尿病
- 吸烟
- 有毒物质或药品的接触
- 男性
诊断性检查
首要检查
- 血清胆红素
- 血清碱性磷酸酶
- 血清γ-GT
- 血清转氨酶
- 血清凝血酶原时间
- 血清CA19-9
- 血清癌胚抗原（carcinoembryonic antigen, CEA）
- 血清 CA-125
- 腹部超声
- 腹部 CT 检查
- 腹部 MRI
需考虑的检查
- 超声内镜 (EUS)
- MR 血管造影术
- ERCP
- 磁共振胰胆管造影术 (MRCP)
- 经皮肝脏穿刺插管（PTC）
- 正电子发射断层成像 (positron emission tomography, PET)
- 免疫染色
新兴检查
- 光学相干断层扫描 (OCT)
- 经口胆管镜检查术
- 十二指肠镜辅助下胆道镜检查
治疗流程
可切除肿瘤
不可切除肿瘤
撰稿人
作者
N. Joseph Espat, MD, MS, FACS
Chairman of Surgery
Professor and Chief Surgical Oncology
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 Associate Chief
Surgical Oncology
Department of Surgery
Roger Williams Medical Center
Boston University School of Medicine
Providence
RI
利益声明
PS is an advisory board member for RWMC, and a clinical board consultant for Medtronic HPB.
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.
鉴别诊断
- 肝细胞肝癌
- 壶腹癌
- 胰腺瘤
更多 鉴别诊断指南
- AASLD 原发性硬化性胆管炎和胆管癌实践指导
- 胆道癌：ESMO 诊断、治疗和随访临床实践指南
更多 指南
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