15. Zināt cēloni un to novērst
Ķirurģiska iejaukšanās – likvidējot
Aknu transplantācija
▪ netiek veikta augstā recidīva riska dēļ
▪ saslimšana atkārtojas
▪ labāki rezultāti, ja pirms tam veikta ķīmijterapija
Ķīmijterapija
Endoskopiskā terapija
Lesion - bojājums
The Bismuth classification of hilar cholangiocarcinoma into type I to IV stages is illustrated. Yellow areas represent tumor and brown areas normal bile duct.
Cholangiocarcinomas are classified according to their anatomic location as intrahepatic and extrahepatic
Hilar cancers that arise from extrahepatic large duct epithelium at the hilum can extend into the liver, and have been misclassified as intrahepatic in some schema and in epidemiological and clinical reports. Further subclassification on the basis of macroscopic or microscopic characteristics can provide additional distinction that might correlate with clinical outcomes. Cancers that arise from the gall bladder or the ampulla of Vater are biliary tract cancers with unique clinical presentations, natural history, etiology and patterns of growth or spread and are considered separately from cholangiocarcinoma.
A, Cholangiocarcinoma within a cirrhotic liver; B, cross-section of tumor; C, histological imaging showing tumor cells surrounding normal hepatocytes.
Caroli’s slimība ( A-R, policistiska nieru saslimšana, žultsvadi tiek dilatēti)
Holangīts – žultsvadu iekaisums
Asinsaina – hematokrīts, trombocītu,
CT (kompjutertomogrāfija abdomināla) , Comparison of radiographic images showing cholangiocarcinoma; A, computed tomography (CT) image; B, cholangiogram (ERCP) image. Arrows designate the tumor.
MRI – magnētiskā rezonanse
Endoskopija - esophagus, stomach and beginning of the lower intestine without surgery.
You will be lightly sedated and your doctor will insert an endoscope through the mouth, down the esophagus, and into the stomach and small bowel. A smaller tube or catheter is passed through the endoscope and into the bile ducts. Dye is injected into the ducts, and the doctor takes X-rays that can show whether a tumor is present in the bile ducts.
Aizliegta ēšana un perorālu medikamentu lietošana vismaz 6 stundas, dzeršana - 2 stundas pirms endoskopijas.Dienā pirms izmeklēšanas: vieglas vakariņas ne vēlāk kā 20.00, pēc tam dzert tikai ūdeni bez gāzes.
P.S. Augšējās endoskopijas laikā bez speciālas iepriekšējas pacienta sagatavošanas vajadzības gadījumā ir iespējams veikt dažādas diagnostiskas un terapeitiskas manipulācijas kā biopsijas, asiņošanas apturēšanu, polipa izgriešanu, svešķermeņu izņemšanu un tml.
In this procedure, a thin needle is inserted through the skin and into the bile ducts. A dye is injected through the needle so that a contrast image will show up on X-rays. By looking at the X-rays, the doctor may be able to see whether there is a tumor in the bile ducts.
Ķīmijterapija – pēc audzēja izgriešanas
Endoskopiskā terapija – stenta ievietošana mazina blokādes žultsvadā, mazina dzelti, tajās situācijās, kad audzēju nevar likvidēt