最后审阅: 22 五月 2021
最后更新: 02 七月 2020

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

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CA19-9+(40倍于CEA
  • 血清 CA-125
  • 腹部超声

需考虑的检查

  • 腹部 CT 检查
  • 腹部 MRI
  • 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

撰稿人

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 is a consultant for SIRTEX Medical, Medtronic, and IV Diagnostics on technical and biologic concepts of device performance. These positions are not relevant to the topic area.

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 declares that he has no competing interests.

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Assistant Professor

Department of Surgery

Health Science Center

SUNY

Stony Brook

NY

利益声明

KW declares that he has no competing interests.

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.

Consultant in Surgical Oncology

The Royal Marsden Hospital

London

UK

利益声明

SM declares that he has no competing interests.

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