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Laparoscopic anatomic hepatectomy (LAH) has been widely approved as an essential procedure for safety and availability, and has gradually become the mainstream method of hepatec-tomy. Through a renewed understanding of the Laennec capsule, the authors have found that there exists a natural gap between the Laennec capsule and the adjacent tissues, such as Glisson pedicles and hepatic veins. Consequently, Laennec capsule can serve as the anatomical approach for LAH. The left lobe, right anterior lobe and right posterior lobe has an independent Glisson pedicle respectively, which can be used to perform Glisson pedicle transection sectionectomy via Laennec capsule approach without damaging the liver parenchyma. The exposure of hepatic veins on the detached plane can also be achieved through this approach. Laennec capsule approach provides a new idea for laparoscopic anatomic liver sectionectomy, which is safe, reliable, convenient and highly repeatable.
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Objective:To explore the clinical efficacy of microwave ablation under CT-guidance for patients with liver cancer of the first hepatic hilar region at advanced period.Methods: 56 patients with liver cancer of the first hepatic hilar region at advanced period, who had lost the chance of operative treatment, were divided into observation group (28cases) and control group (28cases) as the random number table. The patients of observation group received CT-guidance microwave ablation and other targeted combining therapy while patients of control group underwent routine chemotherapy of arterial embolism. The therapeutic effect and survival situation of the two groups were compared and analyzed.Results: The total effective rate of patients with liver cancer of the observation group(82.14%) was significantly higher than that of control group (46.43%)(x2=7.778,P<0.05). The AFP of both of the two group was obviously reduced, and the improvement degree of observation group was significantly better than that of control group (t=14.662,P<0.05). The survival rate of post-operative 1-2 y of observation group was slightly higher than that of control group, but it was no significant (x2=4.156,x2=0.080,P>0.05).During the process of treatment and post the process of treatment, the occurrence rate of adverse reaction of observation group was significantly lower than that of control group (x2=6.842,P<0.05).Conclusion: The microwave ablation under CT-guidance and other targeted combining therapy has outstanding advantages including simple operation, curative precision and so on. And it has better curative effect for patients with liver cancer of the first hepatic hilar region at advanced period who had lost optimum opportunity of operative treatment. Besides, its adverse reaction is lower and it has obviously preponderance to compare with routine arterial embolism.
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Objective:To explore the clinical efficacy of microwave ablation under CT-guidance for patients with liver cancer of the first hepatic hilar region at advanced period.Methods: 56 patients with liver cancer of the first hepatic hilar region at advanced period, who had lost the chance of operative treatment, were divided into observation group (28cases) and control group (28cases) as the random number table. The patients of observation group received CT-guidance microwave ablation and other targeted combining therapy while patients of control group underwent routine chemotherapy of arterial embolism. The therapeutic effect and survival situation of the two groups were compared and analyzed.Results: The total effective rate of patients with liver cancer of the observation group(82.14%) was significantly higher than that of control group (46.43%)(x2=7.778,P<0.05). The AFP of both of the two group was obviously reduced, and the improvement degree of observation group was significantly better than that of control group (t=14.662,P<0.05). The survival rate of post-operative 1-2 y of observation group was slightly higher than that of control group, but it was no significant (x2=4.156,x2=0.080,P>0.05).During the process of treatment and post the process of treatment, the occurrence rate of adverse reaction of observation group was significantly lower than that of control group (x2=6.842,P<0.05).Conclusion: The microwave ablation under CT-guidance and other targeted combining therapy has outstanding advantages including simple operation, curative precision and so on. And it has better curative effect for patients with liver cancer of the first hepatic hilar region at advanced period who had lost optimum opportunity of operative treatment. Besides, its adverse reaction is lower and it has obviously preponderance to compare with routine arterial embolism.
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Objective To discuss the clinical application of percutaneous transhepatic cholangiopancreatic drainage (PTCD) combined with CT-guided microwave ablation in treating hepatic hilar cholangiocarcinoma. Methods The clinical data of 29 patients with inoperable Ⅲ and Ⅳ type hilar cholangiocarcinoma complicated by obstructive jaundice, who were admitted to authors’ hospital during the period from December 2012 to August 2014, were retrospectively analyzed. The diagnosis of bile duct adenocarcinoma was confirmed by pathology in all patients. Of the 29 patients, both internal and external biliary tract drainage was employed in 19, external biliary tract drainage in 4, and bilateral (both left and right side) bile duct drainage in 6. CT-guided microwave ablation was carried out when the liver function became improved. A total of 46 procedures of microwave ablation were completed in the 29 patients with a mean of 1.5 times per patient. Hepatic function tests, enhanced CT or MR scan were performed 4-8 weeks after treatment. According to mRECIST criteria the therapeutic results were evaluated; the serum bilirubin levels were recorded; the disease progress and the patient’s survival time were followed up. Results One month after the treatment, complete response (CR) was obtained in 15 patients (15/29, 51.7%), and partial remission (PR) in 17 patients (17/29, 58.6%), with the overall efficacy (CR﹢PR) being 82%. After the treatment, one patient developed hepatic metastasis and another one had pulmonary metastasis. Postoperative serum bilirubin levels showed an obvious decrease in all 29 patients. The 6-month, one-year and two-year survival rates were 68.9% (20/29), 31.0% (9/29) and 6.8% (2/29) respectively; the median survival time was 8.9 months and the overall survival time was 11.7 months. Conclusion For the treatment of hepatic hilar cholangiocarcinoma, PTCD combined with CT-guided microwave ablation is minimally invasive, clinically safe and effective.
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Objective To explore the reasons of biliary restenosis after interventional treatment for malignant obstructive jaundice caused by hepatic hilar cholangiocarcinoma and to discuss its management. Methods During the period from June 2010 to Sep. 2013 at authors’ hospital, a total of 36 patients with high biliary obstruction caused by Bismuth Ⅱ - Ⅳ type of hepatic hilar cholangiocarcinoma received percutaneous transhepatic cholangial stenting (PTCS), and as the patients developed biliary restenosis after PTCS percutaneous transhepatic cholangial drainage (PTCD) had to be carried out. All the patients had complete data. Serum total bilirubin, direct bilirubin, glutamyltranspetidase and alkaline phosphatase levels were determined on the operation day and at five days after PTCS and PTCD. The short - term remission of malignant obstructive jaundice produced by PTCS and PTCD were assessed. The causes of biliary restenosis were analyzed by comparing the CT and/or MRI images as well as the cholangiography and drainage test results which were performed at the first and second admission to hospital. Results The interval time from operation to restenosis was 31 - 468 days, with an average of 132.8 days. The effective rates of PTCS and PTCD for relieving jaundice were 77.8% and 75.0% respectively. The main causes of restenosis included the formation of biliary sludge, acute cholangitis and tumor growth. Conclusion PTCS is an effective means to relieve the malignant obstructive jaundice caused by hepatic hilar cholangiocarcinoma, however, the incidence of biliary restenosis after PTCS is higher, which may be mainly due to the tumor growth. Nevertheless, subsequent PTCD can effectively improve the liver function, control biliary infection, remit biliary obstruction and relieve the clinical symptoms.
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Objective To evaluate the role of MR imaging and MR cholangiopancreatography(MRCP) for the diagnosis of hepatic hilar cholangiocarcinoma and assessment of tumor resectability.Methods MR imagings were analyzed retrospectively and compared with surgical result in 20 patients with hepatic hilar cholangiocarcinoma.Results The tumor masses were found in the hilar regions on the MR images for 18 patients. It was found that only dilatation of the intrahepatic biliary tree and thickness of the bile duct wall for the other 2 patients. According to the Bismuth classifying, classification of MR was: typeⅠ (n=3), typeⅡ(n=4), type Ⅲ(n=6),type Ⅳ(n=7). Compared with the operative findings, the accurate ratio of classification was 80%, sensitivity specificity and coincidence was 75%, 75%,80% for the assessment of tumor resectablility by MR. Conclusion MRCP combined with MRI is very useful for diagnosis and classification of the hepatic hilar cholangiocarcinoma and assessment of tumor respectability.