ABSTRACT
The radical resection is the only curative way for hilar cholangiocarcinoma,and combined hepatectomy is usually needed to achieve the goal of radical resection.Most patients with hilar cholangiocarcinoma are accompanied by obstructive jaundice.Although preoperative biliary drainage (PBD) can improve liver function,blood coagulation function,nutritional status and immunologic function,control acute cholangitis and promote liver regeneration,but a series of its drawbacks currently lead to a big controversy about application value of radical resection of hilar cholangiocarcinoma.Through reviewing literatures and combining with clinical practice experiences,author suggested some ideas on effects,disadvantages,application value,indication and method selection of PBD that will provide a reference in clinical practices.
ABSTRACT
BACKGROUND/AIMS: Endoscopic sphincterotomy is considered the primary option for treatment of common bile duct (CBD) stones. In some cases, however, complete stone removal is difficult or even impossible. Endoscopic retrograde biliary drainage (ERBD) has been suggested to be an alternative treatment in such cases or in patients with high surgical risks. In this study, we evaluated the effectiveness of ERBD using a plastic stent for treatment of CBD stones. METHODS: From Mar. 1996 to Aug. 1999, ERBD was performed in 12 patients with CBD stones. Indications for ERBD were old age in 4, a large perivater diverticulum in 4, refusal of surgery in 2, bleeding risk and biliary stricture in 1 each. Nine had one of the significant associated medical conditions. RESULTS: Six of the 12 patients were symptom-free at the time of evaluation (mean 32.9 months). Of the remaining 6 patients, 3 had operation, 1 had a successful endoscopic stone removal, 1 had a stent exchange, and 1 was lost to follow-up at 26 months. Thus, overall success rate of ERBD for treatment of CBD stones was 75% (9/12). Median symptom-free duration was 41 months (range 18~59 months). CONCLUSIONS: In view of its relatively high success rate and long-term effect, ERBD is an alternative modality for treatment of CBD stones, especially in patients with high surgical risks.