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Современные методы диагностики холангиоцеллюлярного рака

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Цель: представить особенности современной диаг­ностики холангиоцеллюлярного рака (ХЦР). Основные положения. В статье описана классифи­кация, частота встречаемости, факторы риска развития ХЦР. Рассмотрены диагностические возможности транс­абдоминального, эндоскопического и внутрипротоково-го УЗИ, а также РКТ, МРТ, ПЭТ и холангиографии в обна­ружении внутри- и внепеченочной формы ХЦР, локоре-гионарного распространения опухоли. Расширение желчного протока на ультразвуковых томограммах - важный признак для ранней диагностики рака желчного протока и повод для проведения более масштабного обследования с применением других ин­формативных методов. УЗИ - метод выбора при прове­дении интервенционных процедур, таких как чрескож-ная чреспеченочная холангиография и дренирование перибилиарных абсцессов. Разработка новых методов исследования желчных протоков привела к использова­нию УЗИ при проведении эндоскопии - эндоскопичес­кого УЗИ и при проведении холангиопанкреатографии -транспапиллярного внутрипротокового УЗИ. Выводы. Большинство авторов считают, что диагнос­тические методы для карциномы желчных протоков без желтухи включают УЗИ, МРХПГ, ЭУЗИ, ЭРХПГ и внутри-протоковое УЗИ, а с желтухой УЗИ, РКТ или МРТ, пункцию под контролем ЭУЗИ, ЭРХПГ. ПЭТ с успехом справляется с диагностикой внутрипеченочной формы ХЦР, но имеет низкие показатели информативности в обнаружении вне- печеночного ХЦР. Ее роль заключается в выявлении от­даленных метастазов и оценке эффективности лечения.

Ключевые слова:
холангиоцеллюлярный рак, желту­ха, ультразвуковое исследование, рентгеновская компью­терная томография, магнитно-резонансная томография, позитронно-эмиссионная томография.

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Modern Diagnostic Methods of Cholangiocarcinoma

The purpose: submit a feature of modern diagnostics cholangiocarcinoma. The main provisions. The article describes the classifi­cation, incidence, risk factors for cholangiocarcinoma. Considered diagnostic capabilities of techniques of trans­abdominal, endoscopic and intraductal ultrasound and CT MRI, PET and cholangiography in the detection of extrahep-atic and intrahepatic cholangiocarcinoma, locoregional tumor spread. The expansion of the bile duct on ultrasound tomo­grams - an important feature for the early diagnosis of cancer of the bile duct and the reason for a larger survey using other informative methods. Ultrasound examination - the method of choice for interventional procedures such as percutaneous transhepatic cholangiography and drainage of abscesses peribiliary. The development of new methods of investigation bile duct led to the use of ultrasound during endoscopy -endoscopic ultrasound and during cholangiopancreatogra-phy - transpapillary intraductal ultrasonography. Conclusion. Most authors believe that the diagnostic methods for bile duct carcinoma without jaundice include ultrasound, MRCP, EUS, ERCP and intraductal ultrasound. Diagnostic methods for carcinoma of the bile duct with jaun­dice: ultrasound, CT or MRI, puncture under the control of EUS, ERCP. PET successfully identifies intrahepatic cholan-giocarcinoma, but has a poor performance in detecting informative extrahepatic cholangiocarcinoma. Its role is to identify distant metastases and assessment of treatment efficacy.

Keywords:
cholangiocellular cancer, jaundice, ultra­sound, x-ray computed tomography, magnetic resonance tomography, positron emission tomography.