RESUMO
Objective To investigate the surgical method and clinical efficacy of hilar cholangio carcinoma in Bismuth type Ⅳ.Methods The retrospective descriptive study was adopted.The clinical data of 1 patient with hilar cholangiocarcinoma in Bismuth type Ⅳ who was admitted to the Renji Hospital affiliated to Shanghai Jiaotong University in October 2014 were collected.The patient had complaint about right upper abdominal pain for half month.Enhanced CT scan showed soft-tissue mass at hepatic hilum.After accurate assessment,the patient underwent radical resection of hilar cholangiocarcinoma + right hemihepatectomy + perihilar resection + right caudate hepatectomy + Roux-en-Y hepaticojejunostomy.The operation time,volume of intraoperative blood loss,results of pathological examination,postoperative complications,time of drainage tube removal,discharge time and follow-up were observed.The follow-up was performed to detect the life quality and tumor recurrence by outpatient examination and telephone interview up to July 2015.Results The patient received successful radical resection of hilar cholangiocarcinoma + right hemihepatectomy + perihilar resection + right caudate hepatectomy + Roux-en-Y hepaticojejunostomy.Operation time and volume of intraoperative blood loss were 480 minutes and 300 mL,respectively.The result of pathological examination showed that the size of hilar bile duct was 4 cm× 3 cm × 2 cm and poor-differentiated adenocarcinoma infiltrated through bile duct into liver tissues and right branch of portal vein.Two lymph nodes in the 8th group,1 in the 12a group and 3 in the 12p group were positive by detection,showing the metastasis of cancer cells.The resection margins of liver and bile ducts were negative,achieving a R0 resection.The patient had a removal of negative pressure drainage tube at postoperative day 7 and discharged from hospital at postoperative day 12,with a good recovery and without the complications of biliary fistula,abdominal infection and hepatic failure.During the 9-month follow-up,there was a good life quality and no tumor recurrence.Conclusion The radical resection rate of Bismuth type Ⅳ tumor can be increased by accurate preoperative evaluation,rational surgical approach,individualized surgical planning and precise intraoperative procedures.