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Objective To investigate the clinical manifesfations and diagnostic and therapeutic features of cholangiocarcinoma associated with hepatolithiasis.Methods The clinical data, the diagnotic and therapeutic featares of 54 cases of cholangiocacinoma associated with hepatolithiasis were retrospectively analyzed.Results The occurrence rate of hepatolithiasis concomitant with hepatocholangiocarcinoma was 11.8%.Due to a lack of specific clinical manifestations, the preoperative diagnosis of this condition was difficult. In this series, the (correct) diagnotic rate of hepatocholangiocarcinoma before operation was only 11.1%. The radical resection rate was 51.8%. Radical resection of the tumor had a better prognosis than that of non-resection of tumor.(Conclusions) Patients with long-term recurrent hepatolithiasis tended to have associated cholangiocarcinoma. Early diagnosis of the disease was difficult, and the treatment results and prognosis were poor. Therefore, (patients) with hepatolithiasis, espesially those with recurrent attacks, should undergo operation early. In cases diagnosed as hepatic cholangioearcinoma at operation, a radical resection should be performed, if possible, and a favorable outcome may be attained.
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Objective Because of local infiltrated growth and spread,the operative resection of hilar (cholangiocacinoma) is very difficult. Recently,combined extended hepatectomy and vascular resection had been performed for treatment of hilar cholangiocarcinoma and has greatly increased the resection rate and survival rate.However, it is associated with high operative morbidity and mortality. The aim of this study is to explore a reasonable hepatic resection strategy, that is safe and beneficial for the patient. Method Sixteen (consecutive) cases of hilar cholangiocarcinoma with involvement of hilar vessels have been treated in our hospital since 1977. En bloc resection of the hilar tumor that included hepatic segment I,IV and involved blood (vessel), as well as hepato-duodenal ligament skeletonization was performed in 15 patients. Results All 15 cases were successfully operated on with a resection rate of 93.8%, and 12 cases with R_0 resection. The operative mortality and in-hospital mortality rate were 0. Temporary bile leak and abdominal infection (respectively) developed in 1 patienteach,with an overall morbidity of 13.3%,and both were cured by non-(operative) therapy. No case of liver failure occurred. Follow up showed the median survival was 22 months and 7 are still alive. Conclusions (1)The resection rate and survival rate for hilar cholangiocarcinoma could be improved by combination of liver and hilar vascular resection.(2)Hilar cholangiocarcinoma mainly spreads to the medial segment(S4) and caudate(S1), and these segments need to be resected in the combined (operation).(3)Although resection of the middle part of liver takes little more time than hemi-hepatectomy and trisegmentectomy, it could preserve more liver parenchyma and reduce postoperative morbidity (such as liver failure) and mortality rates.(4)The resection of the hilar blood vessel involved by tumor was necessary to improve the resection rate and cure rate. Reconstruction of the blood vessel was made selectively by taking the circumstances into consideration.
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Objective To study the diagnosis and radical resection of hilar cholangiocarcinoma. Methods Retrospective analysis was made on the clinical feature and the effect of radical resection on 38 cases of hilar cholangiocarcinomas.Results Diagnosis was made in all of the patients preoperatively.The radical resection was perfomed on 38 patients.Of them, 3(7.9%) died after operation.After operation, 5 cases (13.2%) developed bile leakage,and 2 of the 5 cases developed subphrenic abscess,which were cured by drainage; 4(10.5%) had right hydrothorax that was cured by conservative therapy; and 3(7.9%)had incision split that was cured by resuture. Among the 35 postoperative survivors,34 (97.1%) were followed up, the 1- and 3-year survival rates were 91.9% and 35.2%.None of the patients survived for 5 years. Conclusions It′s still difficult to make early diagnosis in hilar cholangiocarcinoma.The diagnosis mainly depends on the combination of imaging examinations. Nowadays the radical resection rate of hilar cholangiocarunoma is still low, the recurrence and metastasis are common after operation, and few patients can survive for a long time. It suggests that even in radical operation for hilar cholangiocarcinoma, the regions of resection and sweep are not enough,and the operative procedure needs to improve further.
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Objective To investigate the postoperative complications, survival and the prognostic factors of surgical treatment of distal cholangiocarcinoma . Methods The clinical data of 23 patients with distal cholangiocarcinoma treated by operation in our department in recent 12 years were reviewed retrospectively. Results The persistent period of symptoms befor operation in patients without postoperative complications ( 1.29?0.23 months) was significantly longer than that in patients with complications (0.50?0.18 months) (P
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Objective To study the operative procedure for stage III and IV hilar cholangiocarcinoma. Methods A crescent shape excision on the edges of multiple hepatic segments followed by a 'skirt edge′ form hepatoenterostomy to drain the multiple hepatic ducts was used to treat unresectable stage III,IV hilar cholangiocarcinoma, . Results (1)the mean survival time was 15.65 months;(2)the patient comfortable index was 81.5%;(4)there was no operative death in the series. Conclusions The 'skirt edge' form hepatoenterostomy is a feasible and effective palliative method for unresectable stage III,IV cholangiocarcinoma.
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Objective To detective the carcinogenesis and operation principle of cyst canceration after internal drainage(ID) operation for congenital choledocal cyst (CCC).Methods The clinical data of 25 patients with cyst carcinoma after ID operation for CCC in the past 28 years were analysed retrospectively.Results The total canceration rate after internal drainage of CCC were 30.49%(25/82); after cystoduodenostomy was 35.29%(14/51),after cystojejunostomy was 22.58%(11/31), respectively. In the 25 cases, three of them were operated with Wipple operation , 4 with tumour resection plus biliary reconstrustion operation, 4 local resection with external drainage ,14 with external drainage only. Conclusions Internal drainage of CCC should be aborted becaus of the high canceration rate after the operation.
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Objective To improve the level of diagnosis and treatment of hilar cholangiocarcinoma by investgating it′s clinical characteristics.Methods The clinical data of 98 patients with hilar cholangiocarcinoma were analyzed retrospectively.Results According to the Bismuth-Corlitte grouping: typeⅠ,8 cases;typeⅡ,19 cases;type Ⅲ,17 cases;type Ⅲb,14 cases;and type Ⅳ,40 cases.Radical resection(49),palliative operation(12),endoscopic retrograde biliary drainage(16),and PTCD(5) were performed The median survival time of radical resection group was 28.6 months and the survival rate at 1,2,3,and 5 years was 74.2%,65.3%,37.5%,and 3.9% respectively,while the median survival time of palliative operation group was 17.6 months and the survival rate at 1,2,3,and 5 years was 71.7%,26.8%,8.9%,and 0% respectively.The median survival time of endoscopic retrograde biliary drainage group was 4.5 months and the survival rate at 1,2,3,and 5 years was 21%,13%,and 0% respectively.Conclusions Early diagnosis by adjunctive examinations is vital to treatment of hilar cholangiocarcinoma.Radical resection is the sole procedure to improve the outcome and prognosis of hilar cholangiocarcinoma.Multiple therapeutic methods should be adopted and should be individualized.
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Objective To study the methods and outcome of surgical treatment of distal bile duct carcinoma.Methods The clinical data of 51 cases of distal bile duct carcinoma who underwent surgery were analyzed retrospectively.Of them,28 cases received radical pancreaticoduodenectomy,and 23 cases had internal bile duct drainage procedures.Results The total average survival time was 20 months.The mean survival time of radical and drainage operation was 32 months and 8 months respectively.Postoperative 5-year survival rate in radical pancreaticoduodenectomy group was 17.8%,and in drainage group was 0.The outcome of radical pancreaticoduodenectomy group was significantly better than that of internal bile duct drainage procedures group(P
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Objective To explore the surgical management in patients with Bismuth Ⅳ hilar cholangiocarcinoma.Methods Retrospective study was used to analyze the clinical data with operative and pathologic diagnosis of Bismuth Ⅳ hilar cholangiocarcinoma in the recent five years.Results Of the 22 patients,there were 13 males and 9 females,with M∶F=1.4∶1.In the group of non-liver transplantation(NLTX),5 cases(31.3%) underwent resection(radical resection in 2 cases;palliative resection in 3 cases),and 11 cases had nonresectional internal or external drainage.In the liver transplantation group(LTX),the resection rate was 100 %(6/6).Five LTX cases survived for 28,19,17,12 and 9 months respectively,and one died from chronic rejection in 11 months after operation.In the NLTX group,the 1-and 2-yr survival rate was 32.1 % and 0% respectively.The 1-and 2-yr survival rate of LTX was 80.0 %(4/5)and 50.0 %(1/2)respectively.There was significant difference between the two groups in average survival rate(P=0.041).Conclusions Aggressive surgical treatment should be adopted for Bismuth Ⅳ hilar cholangiocarcinoma,and radical resection is crucial to enhance survival rate.LTX is a good choice for the patients with unresectable Bismuth Ⅳ hilar cholangiocarcinoma and the prognosis is satisfactory.
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Objective To evaluate the diagnosis and surgical treatment of hilar cholangiocarcinoma(H-CC). Methods Retrospective analysis was made on the clinical feature, surgical treatment and the effect on 73 patients with H-CC. Results Diagnosis was made in all of the patients preoperatively and the correct diagnostic rate of BUS was 69.9%. In the treatment, radical resection was performed on 15 patients with good results in a short-term period. Of the 43 patients who underwent biliary tract internal drainage or exterrnal drainage, 37 patients had good results in a short-term period, while 6 died after operation. Laparotomy or hepatic artery cannulization with chemotherapy was performed on 15 patients and no change occurred in a short-term period after operation. In 15 cases subjected to radical resection, 11 cases were followed up. The 1,3-year survival rates was 90.9%, 20.0% respectively, but none of the patients survived for over 5 years. In patients undergoing other operations, none survived more than 9 months. Conclusions It's still difficult to mak early diagnosis of H-CC, which mainly depends on imaging technics. The BUS should be choiced first. Radical resection rate is still low nowadays. The lobus quadratus resection is helpful to select the operation.
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Objective To summarize the methods of diagnosis and operation of carcinoma of the extrahepatic bile ducts. Methods The clinical data of 100 cases of carcinoma of the extrahepatic bile ducts which were treated in our hospital from 1972 to 1999 were retrospectively analysed. In this series, there were 68 cases of the cancer located in the upper portion of exlrahepatic duct(proximal cancer), 12 in midder portion(midder cancer), 18 in lower portion(distal cancer), and 2 in whole bile duct. Results The initial symptom was upper abdominal discomfort or vague pain, abdominal distension, weakness, weight loss and progressive jaundice. BUS, CT and MRI were scatheless. If the intrahepatic bile duct dilatation or extrahepatic cholestatic jaundice were revealed, PTC(13 cases in this series) or ERCP(42 cases in this series) were to further determine the location of tumor. According to the position and type of the tumor, the different operations were selected. Twenty-five cases(36.8%) of the proximal cancer were resected, including 15 cases of type Ⅰ treated with localresection or “skeletonization” resection, 9 cases of type Ⅱ treated with resection of the tumor and caudate lobe, 1 case of type Ⅲb treated with resection of the tumor, caudate lobe and left hepatic trisegmentectomy. Nine cases(75%) of midder cancer were resected. After resected the proximal and midder cancer, bile duct reconstruction by Roux-en-Y hepaticojejunostomy was performed on all the cases. Fourteen cases(77.8%) of distal cancer were treated by pancreatoduodenectomy. The total resection rate in this series was 48%. Of the cancer resected cases, 35 were followed up, the five-year survival rate was 58%. 32 of the 52 cases without cancer resection were followed up, and all of them died one to one and half year after operation. Conclusions BUS, CT and MRI are the first selective methods for early diagnosis of the carcinomas of extrahepatic bile duct. If needed, PTC or ERCP should be done because of these methods have more accurate diagnostic value. Surgical resection of the tumor is the only likelihood for effective treatment.
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Objective To improve the technique of pancreatoduodenectomy in order to facilitate the(management) of complications and direct observation on follow up.Methods Pancreatoduodenectomy and Child′s method of digestive tract reconstruction was performed in 42 paltents.A blind loop of jejunum 5 to 6 cm in length was constructed beyond the pancreatojejular anastomosis and it was fixed to the subcutaneous(tissue) of the adjacent abdominal wall.Results Thirty-two cases recovered uneventfully,and 10 cases had complications induding pancreatic and biliary leakage and hemorrhage.These complications were successfully treated under direct vision by choledochoscope passed into the blind jejunal loop.This method of observation was used for long-time follow up in 22 cases,and revealed ercurrent tumor(n=5),bile duct stricture(n=4) and bile duct ascariasis(n=1).Conclusions This operative method did not cause new(complications) and it can be combined with the traditional operation.Postoperatively,direct observation and management of leakage of pancreatojejular anastomosis and biliointestinal anastomosis and hemorrhage can be accomplished,and the anastomoses and pancreatic stump can be directly observed at followup.
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Objective To explore the factors related to effects and prognosis of surgical treatment of hilar cholangiocarcinoma.Methods The clinical data of 41 patients with hilar choIangiecarcinoma(HCCA) admitted in recent seven years were investigated and anlyzed retrospectively.Results Among 41 patients with HCCA,the accuracy rate of diagnosis by imaging technology was 95.1% before operation.Thirty-two cases were treated by surgical resection,of which 15 cases had radical resection and 17 cases had palliative resection,the total resection rate was 78.1%,and 9 cases had biliary internal drinage procedure.Two cases died during hospitilization.The rate of one-,three-and five-year survival for surgical resection was 70.0%,40.0% and 23.3% respectively,and for palliation drainage was 44.4%,11.1%,and 0%,respectively.The median survial time was 28 months and 8 months for surgical resction and palliation drainage,respectively.The difference between surgical resction and palliation drainage on survival rate and median survival time was signigicant(P
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Objective To evaluate the effect of local resection for the tumor of Vater ampulla. Methods seventeen cases of Vater ampullary tumor were subjected to tumor local resection from November 1987 to December 1998, including 3 adenomas and 14 adenocarcinomas confirmed by pathology. Two methods of excision for the tumor were performed, including through duodenum to perform the tumor local resection in 16 cases, and through common bile duct in 1 case. Results Bile duct infection occurred in 3 cases. There was no death in this series. 12 of the 17 cases (70.6%) had been followed up for 4～61 months, median survival time was twelve months. In three benign cases ,one died with another disease 17 months postoperatively, two still alive well 38 and 7 months after operation respectively. In 14 malignancy, 9 cases (64.3%) had been followed up. Of the 9 cases, 6(66.7%) alived ≥ 12 months, 4 (44.4%) 24 months, two(22.2%) 60 months. Conclusions Local resection of the Vater ampulla tumor has advantages, such as small damage ,less bloodlass, quick recovery and less interference of the body, but it must be performed by rich experienced surgeons. It is suitable for patients with a small benign tumor, or in the high risk patients whose carcinoma showed no invasion or metastasis, and it also can be performed in patients such as those with atypical hyperplasia and suspious malignant tumor.
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Objective To study the treatment of hepatocellular carcinoma(HCC) complicated with bile duct thrombus.Methods Restrospective study was performed on the treatment of 34 cases of HCC complicated with bile duct tumor thrombus from January 1995 to December 2002 admitted to our hospital.Results Among the 34 cases, one patient had no treatment,6 cases received PTCD and 27 cases received operation.In surgical treatment patients,the postoperative 30 days mortality was 22.2%(6/27),the morbidity was 55.6%(15/27).In 16 patients who received hepatectomy with thrombectomy and biliary duct drainage, the survival time was 1～27 months with a median survival time of 16.5 months.Conclusion The prognosis of HCC complicated with bile duct tumor thrombus is poor. Early diagnosis and aggressive operative are the key points to improving the survival time of patients.
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Objective To explore the clinical effects of unilateral placement of plastic stents by ERCP for nonresectable Bismuth type IV hilar cholangiocarcinoma.Methods A prospective study was conducted in 42 patients with nonresectable Bismuth type IV hilar cholangiocarcinoma,who had unilateral insertion of plastic stents in the recent 4 years,All of the patients had successful insertion of single plastic stent by ERCP manipulation.Early results (less than 30 days) of procedure-related complications,mortality,long-term results (greater than 30 days) and survival were observed.Results All of the 42 patients had successful drainage.Mean total bilirubin value decreased from (332.3?163.4)?mol/L to (30.6?18.5)?mol/L,and complete resolution of jaundice was achieved in 61.9% (26/42)of the patients.Early comlications included papilla bleeding due to EST in 4 of 42 patients (9.5%) and acute cholangitis in 10 of 42 patients (23.8%).No procedure-related death occurred.All of the patients needed to have their stents replaced periodically,and the median duration up to the first stent replacement was 65 d,and without significant differences between the two groups in stent insertion to the left and right hepatic duct.Median duration of stent patency was 5.15 months,and median patient survival was 6.5 months,but also no significant differences were found between the two groups.Conclusions Unilateral plastic stent insertion is safe and feasible,can achieve adequate drainage for relatively long time,and can improve life quality and survival for patients with nonresectable hilar cholangiocarcinoma.
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Objective To investigate the risk factors that affect the perioperative mortality incholangiocarcinoma.Methods The clinical data of sixty two patients with cholangiocarcinoma who underwent operation were reviewed retrospectively.Logistic regression test was used in the perioperative mortality study.Before multivariate analysis,each parameter was evaluated with univariate analysis to define whether it was of statistical significance(P
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Objective To summarize twenty year experience in the surgical treatment of hilar cholangiocarcinoma(H CC) and explore the effective measuers for increase in resectional rate and reducing operative morbidity and mortality of H CC. Methods Clinicopathological data of 201 patients with H CC treated surgically in our center between 1978 and 1997 were analysed retrospectively. The resection rate, operative morbidity and mortality of the patients before and after December 1990 were compared. Results Of the 201 patients, 97 underwent resection(redical resection in 51; palliative in 46), 84 subjected to internal or external drainage and 20 only laparotomy. In 75 followed up patients, the 1,3,5 year survival rate was 95.45%, 40.91%, 13.64% in radical resection group, and 55%, 10%, 0% in palliative resection group respectively; whereas in unresectional internal and external drainage group, 1 year survival rate was 36%, noone survived for more than 3 years. All the patients with only laparotomy died within 3 months after operation. Comparation of the two stages revealed that the resection rate had been increased from 34.95% before December 1990 to 62.24% after December 1990, and the radical resection rate from 15.53% to 35.71%, meanwhile the operative morbidity and mortality decreased from 39.80% and 17.84% to 18.37% and 6.12% respectively. Conclusions Radical resection plays an important role for improving long term survival rate in patients with H CC. Appropriately perioperative care can reduce the operative morbidity and mortality.