Surgical Treatment of Bile Duct Cancer at Hepatic Hilum: A Clinical Analysis of 60 Cases / 第三军医大学学报

ABSTRACT

The incidence ot bile duct cancer at hepatic hilum has a tendency to increase in recent years. This paper is to report 60 cases during a 10-year-period from 1975 to -1985. The cancer at the hepatic hilum (60 cases) made up 73% of all extrahepatic bile duct cancers(82 cases),and accounted for 1.65% of 3626 biliary operations done at the same period. The clinical manifestations of the patients could be categorized into three types, the presenting symptoms were obstructive jaundice in 29 cases, of which 25 had been misdiagnosed as infectious hepatitis; the symptoms of acute cholangitis were found in 12 cases; and in 14 cases, various symptoms and signs of biliary diseases had been found for a long time before the diagnosis was established as cancer. In the remaining 5 cases, miscellaneous manifestaions were revealed. The patients were examined with B-US(19 cases), ERCP(10 cases) and PTC(39 cases). The final diagnosis was established according to the findings of PTC and / or ERCP, surgical exploration, or histopathological examination.Surgery was performed on 56 cases. Only 6 out of the 56 received radical resection of the cancer with hemi-hepatectomy; palliative internal drainage of the bile duct was done on 15 cases, external drainage on 23 cases, and other palliative measures on 12 cases. The average survival time after operation was 24.5 months iu 6 cases with radical resection, 8.7 months in 48 cases with palliative measures, and only 5 months in 4 cases without surgical intervention. Ear- ly diagnosis is imperative if successful therapy is expected. It is suggested that a patient over 40 years of age, suffering from "infectious hepatitis" or obstructive jaundice, be watched out for the possibility of hilum cancer, and appropriate examinations such as B-US,CT,ERCP or PTC be carried out. It is emphasized that PTC plays an important role izi the diagnosis of hilum cancer. In severe cases, the intrahepatic bile ducts could be examined with PTC of the two sides at oae time. Exploratory laparotomy should be performed on suspected cases.