ABSTRACT
Objective@#To compare the efficiency between the transhepatic hilar approach and conventional approach for the surgical treatment of Bismuth type Ⅲ and Ⅳ hilar cholangiocarcinoma.@*Methods@#There were 42 consecutive patients with hilar cholangiocarcinoma of Bismuth type Ⅲ and Ⅳ who underwent surgical treatment at Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University from January 2008 to December 2013.The transhepatic hilar approach was used in 19 patients and conventional approach was performed in 23 patients.There were no differences in clinical parameters between the two groups(all P>0.05). The t-test was used to analyze the measurement data, and the χ2 test was used to analyze the count data.Kaplan-Meier analysis was used to analyze the survival period.Multivariate COX regression analysis was used to analyze the prognosis factors.@*Results@#Among the 19 patients who underwent transhepatic hilar approach, 3 patients changed the operative planning after reevaluated by exposing the hepatic hilus.The intraoperative blood was 300(250-400)ml in the transhepatic hilar approach group, which was significantly less than the conventional approach group, 800(450-1 300)ml(t=4.276, P=0.00 1), meanwhile, the R0 resection rate was significantly higher in the transhepatic hilar approach group than in the conventional approach group(89.4% vs. 52.2; χ2=6.773, P=0.009) and the 3-year and 5-year cumulative survival rate was better in the transhepatic hilar approach group than in the conventional approach group(63.2% vs. 47.8%, 26.3% vs. 0; χ2=66.363, 127.185, P=0.000). On univariate analysis, transhepatic hilar approach, intraoperative blood loss, intraoperative blood transfusion, R0 resection and lymph node metastasis were significant risk factors for patient survival(all P<0.05). On multivariate analysis, use of transhepatic hilar approach, intraoperative blood loss, R0 resection and lymph node metastasis were significant independent risk factors for patient survival(all P<0.05).@*Conclusion@#The transhepatic hilar approach is the preferred technique for surgical treatment for hilar cholangiocarcinoma because it can improve accuracy of surgical planning, safety of operation, R0 resection rate and survival rate compared with the conventional approach.
ABSTRACT
Surgical operation is the most important method for the treatment of iatrogenic bile duct injury,and correct selection of the timing of surgical repair is a prerequisite for successful injury repair.This article elaborates on the timing of immediate repair of bile duct injury found during surgery and the timing of delayed repair of bile duct injury found after surgery and summarizes the timing and methods for delayed repair based on the location and manifestations of injuries (such as biliary obstruction,bile leakage,and injury in the choledocho-pancreatico-duodenal junction).It is pointed out that the pathological state of injury is the critical factor for deciding surgical timing.The overall tendency of the timing of repair is early repair,and delayed repair should be performed as early as possible within 2-4 weeks after effective control of inflammation.
ABSTRACT
Gallbladder cancer is the most common malignancy of biliary tract, ranking the sixth among gastrointestinal tract cancers worldwide.However, the low resectability, dissatisfied chemosensitivity and multidrug resistance of gallbladder cancer are currently the major challenges in the clinical management.The drug resistance has been reported to be a rather complex process, mainly involving drug effiux pump, drug-resistance mediating enzymes, transcription factors, cell autophagy and so on.Investigating the potential multidrug resistance mechanisms in gallbladder cancer and clarifying the related influential factors is the key to improving the chemosensitivity of gallbladder cancer.Slacking or reversing the resistance and enhancing the chemosensitivity could provide new idea for treating gallbladder cancer.