ABSTRACT
Background: Tumors of the biliary tract show spectrum ranging from benign to malignant lesions. Only 20% of tumors are resectable at the time of presentation. The operative mortality was approximately 5 to 20%. The morbidity rate associated with the surgery is approximately 65%. Options for palliative therapy of biliary tree obstruction include the surgical bypass, percutaneous external drainage/stenting and endoscopic stenting. The aim was to compare the survival pattern of patients treated with biliary Self Expandable Metallic Stents (SEMS) as a palliative procedure to that of patients treated by curative surgery.Methods: This was a retrospective study. 6-months survival pattern were analysed in 20 patients treated by SEMS and compared with that of 10 patients treated with plastic biliary stents followed by curative surgery.Results: Survival pattern analysis was done for all 20 patients with SEMS. 7 patients were in >1-year survival, 5 were in >6months survival, 6 expired within 6months, 2 patients were lost to follow up. Survival pattern was compared with 10 patients who had plastic stents followed by curative surgery. Only 1 patient had survival rate >1year post-surgery, 5 patients expired post-surgery in <6months, 2 patients expired few weeks after plastic stent deployment, 2 patients were lost to follow up.Conclusions: In patients with biliary malignancies with obstruction, biliary SEMS followed up by palliative chemotherapy had better survival rate than patients who had plastic stents followed up with curative surgical procedures.
ABSTRACT
Cholangiocarcinoma is a malignancy of biliary tract and its incidence has been increasing in recent years all over the world.Meanwhile,there have been advances in techniques for its diagnosis and treatment.Some new methods such as PET,endoscopic ultrasonography and scopic CT can promote the diagnostic rate in the early stage and they have been used for diagnosis and staging of tumors.For those patients with large cholangiocarcinoma in the liver,photodynamic therapy is an effective neoadjuvant treatment.For those patients with unresectable cholangiocarcinoma,organ transplantation might be employed. Classification of cholangiocarcinoma and study on its diagnosis are important for disease evaluation in patients with the disease.
ABSTRACT
PURPOSE: A choledochoscopy is useful for treating stone disease in the biliary tract. In the era of laparoscopic surgery, this method is expected to be used more widely. Its use during surgery may not only aid disease treatment, but may also help in making a differential diagnosis and a decision on the appropriate operative method. The aim of this study was to determine the role of intraoperative choledochoscopy in biliary surgery. METHODS: This study was a prospective analysis for 119 cases of biliary surgery where a choledochoscopy was used at the Ewha Womans University Mokdong Hospital from June, 1999 to February, 2001. An attempt was made to determine if the use of choledochoscopy altered the preoperative diagnosis, added another diagnosis and influenced the surgical treatment. In addition, the frequency of the remnant stones in biliary stone disease, and the complications related with this procedure were evaluated. RESULTS: The male to female ratio was 1:1.53, and the mean age was 61.1 (+/-14.53) years. A choledochoscopy was used in 82 cases (69%) in open surgery, and 37 cases (31%) in laparoscopic surgery. In 31 cases (26.1%), the diagnosis was changed by the choledochoscopic findings. In 9 cases (7.5%), new finding that was not recognized in the preoperative state was added with the use of choledochoscopy. The surgical method was influenced by the use of a choledochoscopy in 39 cases (32.8%). The remnant stones in patients with an intrahepatic duct stone and common bile duct stone were detected in 8 cases and 3 cases, respectively. The respective clearance rate of the stones were 79.5% (31/39) and 94.5% (52/55). There was no complications and side effects associated with the use of choledochoscopy. The mean time for diagnostic use was 14.6 (+/-10.0) minutes and for therapeutic use was 47 (+/-60.4) minutes. CONCLUSION: Intraoperative choledochoscopy provided useful information for a precise diagnosis and assisted in determining the appropriate treatment for biliary disease. Furthermore, it is very important for making a differential diagnosis in patients with an undetermined malignancy.