双语字幕 Cholangiocarcinoma: Presentation, Investigations and Management 胆管癌的症状、检查和治疗 Cholangiocarcinoma is a type of cancer that originates in the bile ducts. The majority are adenocarcinomas. It may affect the bile ducts inside the liver, the intra-hepatic ducts or the bile ducts outside the liver, the extra-hepatic ducts.胆管癌是一种起源于胆管的癌症。大多数胆管癌是胆管腺癌。它可能影响肝内胆管（intra-hepatic ducts）或肝外胆管（extra-hepatic ducts）。 The most common site is the perihilar region which is where the right and the left hepatic duct have joined to become the common bile duct, just after they leave the liver.胆管癌最常发生于肝门周区，即右、左肝管离开肝脏，汇合成胆总管的位置。 The key risk factors for cholangiocarcinoma to remember are primary sclerosing cholangitis, and liver flukes which are a parasitic infection.大家要牢记，胆管癌的关键风险因素是原发性硬化性胆管炎和肝吸虫感染。 A Tom tip for youTom（视频作者）的观点： patients with ulcerative colitis are at risk of developing primary sclerosing cholangitis. Patients that have primary sclerosing cholangitis are at risk of developing cholangiocarcinoma, about 10 to 20 percent. 溃疡性结肠炎患者具有发展为原发性硬化性胆管炎的风险。原发性硬化性胆管炎患者有发展为胆管癌的风险，约占 10-20%。 When it comes to cholangiocarcinoma, primary sclerosing cholangitis is the key risk factor that's worth remembering for your exams. 关于胆管癌，大家需要谨记检查中原发性硬化性胆管炎是关键风险因素。 The other notable cause is parasitic infection with liver flukes which are found in various parts of southeast asia and europe.另一种显著的病因是肝吸虫感染，这种情况常见于东南亚和欧洲的许多不同的地区。 Let's talk about the presentation.我们来探讨一下胆管癌的症状。 Obstructive jaundice is the key presenting feature to remember.大家需要记住，梗阻性黄疸是胆管癌的主要表现特征。 Obstructive jaundice is associated with pale stools, dark urine, and generalized itching.梗阻性黄疸常表现为陶土色大便、小便黄赤，以及全身瘙痒。 Other non-specific signs and symptoms of cholangiocarcinoma include unexplained weight loss, right upper quadrant pain, a palpable gallbladder which is swollen due to an obstruction in the duct that's distal to the gallbladder causing a back pressure of bile building up inside the gallbladder, and finally hepatomegaly.胆管癌的其他非特异性体征和症状包括不明原因体重减轻、右上象限疼痛、可扪及肿大的胆囊（胆囊远端的导管梗阻，导致胆汁背压，在胆囊内积聚，引起肿胀），以及肝肿大。 Courvoisier's law states that if there's a palpable gallbladder and the patient has jaundice, the diagnosis is unlikely to be gallstones. The cause is usually cholangiocarcinoma or pancreatic cancer.Courvoisier 定律指出，如果胆囊增大，且患者出现黄疸，则诊断不太可能是胆结石。病因通常是胆管癌或胰腺癌。 A Tom tip for you, painless jaundice should make you think of cholangiocarcinoma or cancer of the head of the pancreas. Pancreatic cancer is more common, so this is likely to be the answer in your exams.Tom（视频作者）的观点：无痛性黄疸提示胆管癌或胰头癌。胰腺癌更常见，所以检查结果很可能就是胰腺癌。 Let's talk about investigations.我们来看检查方法。 The diagnosis is based on imaging for example a CT or MRI scan, plus histology from a biopsy of the lesion.胆管癌的诊断依据是成像检查，例如CT或 MRI 扫描，以及病变组织学活检。 A staging CT scan involves a full CT of the thorax, abdomen, and pelvis, or CT TAP. This is used to look for metastasis and other cancers.分期 CT 包括胸部、腹部和骨盆的完整 CT 扫描（CT TAP）。它用于查找转移灶和其他癌症。 The tumor marker to remember for cholangiocarcinoma is CA19-9, and CA stands for carbohydrate antigen.大家注意，胆管癌的肿瘤标志物是 CA19-9，CA 代表碳水化合物抗原。 And this is a tumor marker that may be raised in cholangiocarcinoma. It's also raised in pancreatic cancer and a number of other malignant and non-malignant conditions. So it's not very specific.CA19-9 是胆管癌发生时会升高的肿瘤标志物。它在胰腺癌和其他一些恶性和非恶性疾病中也会升高，因此不具有特异性。 If the patient has evidence of obstruction, for example painless jaundice, a magnetic resonance cholangio-pancreatography or MRCP imaging may be used to visualize the biliary system in detail and assess any obstruction.如果证实患者发生梗阻，例如无痛性黄疸，那么可以使用磁共振胆管造影(MRCP)来详细观察胆道系统，并评估任何梗阻。 If there is obstruction in place, an endoscopic retrograde cholangio-pancreatography or ERCP procedure can be used to put a stent in and relieve the obstruction. And it can also be used to obtain a biopsy from the tumor.如果发现梗阻，那么可以采取经内镜逆行性胰胆管造影术(ERCP)，植入支架，并缓解梗阻。它也用于获取肿瘤活检组织。 Finally let's talk about management. Management will be decided at a multi-disciplinary team or MDT meeting.最后，我们来看一下胆管癌的治疗。胆管癌的治疗由多学科团队（MDT）会诊决定。 Curative surgery may be possible in early cases and it may be combined with radiotherapy and chemotherapy. However, in most cases curative surgery is not possible.早期病例可采取根治性手术，联合放疗和化疗治疗。然而，大多数情况下，患者是不能进行根治性手术的。 Palliative treatment may involve stents inserted to relieve any biliary obstruction, surgery to improve symptoms, for example, bypassing biliary obstruction, palliative chemotherapy, palliative radiotherapy, and end-of-life care with symptom control.姑息治疗方法包括植入支架来缓解胆道梗阻、采取手术改善症状，例如胆道旁路手术、姑息性化疗、姑息性放疗，以及临终关怀，症状控制。 相关单词学习
Cholangiocarcinoma
chol•an•gio•car•ci•no•ma/kəʊlədʒiːəʊkɑːsɪ'nəʊmə/n. 胆管癌 A usually slow-growing malignant tumor of the bile duct that arises from biliary epithelium and is typically an adenocarcinoma. 单词 cholangiocarcinoma由下列成分构成 cholangio- 胆管+carcinoma 癌（图源：太帅图库）
chol•an•gi•tis/koʊlæn'dʒaɪtɪs/n. 胆管炎Inflammation of a bile duct or the entire biliary tree. 单词 cholangitis由下列成分构成 cholangio- 胆管+-itis（后缀）炎症（图源：太帅图库）
Hepatomegaly
hep•a•to•meg•a•ly/hepətoʊ'megəlɪ/n. 肝肿大An abnormal enlargement of the liver, usually associated with liver disease or heart failure. 单词 hepatomegaly由下列成分构成 hepato- 肝+-megaly（后缀）肿大（图源：太帅图库）
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