RESUMEN
Objective To study the prognostic factors in cholangocarcinoma(CC). Methods Retrospective analysis of the reported clinical data of CC in lectures. Results and Conclusions The prognosis of CC in lower portion of bile duct(BD) is much better, CC in meddle portion of BD take the second place of prognosis, CC in upper portion of BD has the worst prognosis. If CC with following cases, which would have much better prognosis: higher differentiation without metastasis, diploid, higher PCNA; if CC with negative expression of epithelial membrane antigen or keratine, which would have worse prognosis. The activate of type IV collegen is related linearly to the metastasis capacity of the tumor, and the expression of nm23 of tumor is related to invation, lymphatic metastasis and prognosis of the tumor. Radical resection of the tumor has the best effect, palliative resection take the second place of prognosis, internal or external drainage operation has the worst effect. The effect of local radiotherapy is limited, and chemotherapy showes no effect. Early diagnosis, radical or extending resection and combined therapy can improve the prognosis of CC.
RESUMEN
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.
RESUMEN
Objective To investigate the correlation between the expression of Cyclin D1,Rb and clinicopathologic parameter in bile duct carcinoma(BDC), and evaluate the potential prognostic value. Methods The expression of Cyclin D1, Rb in BDC was detected by immunochemical staining(S-P method). Results Of 42 samples, 22 cases exhibited Cyclin D1 positive expression(52.38%), correlated with histological grade(P=0.044), hepatic invasion(P=0.0046), clinic stage(P=0.0001) and survival time(P=0.0011). The Rb positive rate was 57.14%(24/42), while the expression was related to histologic grade(P=0.0052), clinic stage(P=0.0042), and lymphatic metastasis(P=0.0068). Conclusions Ccylin D1 and Rb are correlated with some clinicopathologic parameter of BDC, and Cyclin D1 is a valuable prognostic marker of BDC.
RESUMEN
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.