浙江大学医学院：《内科学》课程教学资源（PPT课件）胆管肿瘤 Biliary Tumor

Biliary Tumor XuⅩiao M.D. Ph.D The First Affiliated Hospital, Zhejiang University School of Medicine The Key laboratory of Combined Multi-Organ Transplantation Ministry of Public Health Hangzhou, China

The First Affiliated Hospital, Zhejiang University School of Medicine The Key Laboratory of Combined Multi-Organ Transplantation Ministry of Public Health Hangzhou, China Xu Xiao M.D. Ph.D. Biliary Tumor

The Biliary anatomy Rt hepatic duct Lft. hepatic duct Rt hepatic a Portal v Gastroduodenal a Common hepatic a Common patic duct Cystic a Cystic duct Corpus Hartmanns Common uch bile duct Common Fundus Pancreatic Papilla duct

The Biliary Anatomy

Cystic Triangl le 胆囊三角( cystic triangle 胆囊三角 Caot三角) 肝总管、肝下缘和胆囊管围的三角区 胆囊动脉、肝右动脉、胆囊淋巴结 及副右肝管在胆囊三角经过 肝总管 胆管

Cystic Triangle 胆囊三角（cystic triangle） 肝总管、肝下缘和胆囊管围的三角区 胆囊动脉、肝右动脉、胆囊淋巴结 及副右肝管在胆囊三角经过 胆囊管 肝总管

Physiology Bile ducts Q Intrahepatic biliary tract Q Extrahepatic biliary tract Gallbladder Q Concentrates and stores hepatic bile during the fasting state and delivers bile into the duodenum in response to a meal o The gallbladder epithelial cell secretes at least two important products into the gallbladder lumen: glycoproteins and hydrogen ions Sphincter of oddi It creates a high-pressure zone between the bile duct and the duodenum o The sphincter regulates the flow of bile and pancreatic juice into the duodenum prevents the regurgitation of duodenal contents into the biliary tract

Physiology ➢Bile Ducts ◆ Intrahepatic biliary tract ◆ Extrahepatic biliary tract ➢Gallbladder ◆ Concentrates and stores hepatic bile during the fasting state and delivers bile into the duodenum in response to a meal ◆ The gallbladder epithelial cell secretes at least two important products into the gallbladder lumen: glycoproteins and hydrogen ions ➢Sphincter of Oddi ◆ It creates a high-pressure zone between the bile duct and the duodenum ◆ The sphincter regulates the flow of bile and pancreatic juice into the duodenum, prevents the regurgitation of duodenal contents into the biliary tract

frequently used Assistant Examination 512X512 O0 RI ERCP 0. mA Tilt: 0.0 0.US Id: DCM/ Lin: DCM/d忑 cT chola ngiogra m shows enha nced imaging of the biliary system compa rable to MRC Intra he patic and extra hepatic biliary ducts are clearly seen in this patient. PTCD

Frequently used Assistant Examination CT cholangiogram shows enhanced imaging of the biliary system comparable to MRC. Intrahepatic and extrahepatic biliary ducts are clearly seen in this patient. PTCD ERCP

Malignant Biliary disease >Gallbladder cancer Bile duct cancer )Metastatic and Other Tumors

Malignant Biliary Disease ➢Gallbladder Cancer ➢Bile Duct Cancer ➢Metastatic and Other Tumors

Gallbladder cancer Gallbladder cancer Lymph node Metastasis B,3639/88

Gallbladder Cancer

Gallbladder cancer >An aggressive malignancy that occurs predominantly in elderly people Besides the exceptional cases detected incidentally at the time of cholecystectomy for gallstone disease, which are usually early stage, the prognosis for most patients is poor >Reported 5-year survival rates: 5%38%

➢An aggressive malignancy that occurs predominantly in elderly people. ➢Besides the exceptional cases detected incidentally at the time of cholecystectomy for gallstone disease, which are usually early stage, the prognosis for most patients is poor. ➢Reported 5-year survival rates:5% ~38%. Gallbladder Cancer

Gallbladder cancer >Incidence o Cancer of the gallbladder is two to three times more common in women than men, in part because of the higher incidence of gallstones in women More than 75% of patients with this malignancy are older than 65 years o The incidence of gallbladder cancer varies considerably with both ethnic background and geographic location

Gallbladder Cancer ◆ Cancer of the gallbladder is two to three times more common in women than men, in part because of the higher incidence of gallstones in women. ◆ More than 75% of patients with this malignancy are older than 65 years. ◆ The incidence of gallbladder cancer varies considerably with both ethnic background and geographic location. ➢Incidence

Gallbladder cancer >Risk Factors ◆ Gallstones Calcified gallbladder(porcelain) o Biliary Salmonella typhi infection ◆ Biliary adenomas llbladder Cystic duct Common bile duct

Gallbladder Cancer ➢Risk Factors ◆Gallstones ◆Calcified gallbladder (porcelain) ◆Biliary Salmonella typhi infection ◆Biliary adenomas