Subject(s)
Carcinoma, Hepatocellular , Colorectal Neoplasms , Hepatectomy/methods , Liver Neoplasms , Liver , Portal Vein/surgery , Adult , Carcinoma, Hepatocellular/secondary , Carcinoma, Hepatocellular/surgery , Colorectal Neoplasms/secondary , Colorectal Neoplasms/surgery , Female , Hepatectomy/adverse effects , Humans , Ligation , Liver/blood supply , Liver/surgery , Liver Neoplasms/pathology , Liver Neoplasms/surgery , Male , Middle AgedABSTRACT
BACKGROUND: Hilar cholangiocarcinoma (HCCA) is a rare tumor, usually associated with obstructive jaundice and unfavorable prognosis. Obstructive jaundice can affect the liver, kidney, heart, and the immune system of the patients. Currently, controversy exists in whether preoperative biliary drainage (PBD) is of any benefit to the patients, and the best way for PBD in patients with resectable HCCA of malignant biliary obstruction remains to be determined. OBJECTIVES: To compare the clinical outcomes and effectiveness of endoscopic biliary drainage (EBD) treatment with those of percutaneous transhepatic biliary drainage (PTBD) treatment in patients with malignant biliary obstruction caused by resectable HCCA. MATERIALS AND METHODS: The databases including MEDLINE, EMBASE, PubMed, CBM (China Biological Medicine Database), and CNKI were employed to identify the clinic trials on EBD versus PTBD for malignant biliary obstruction associated with resectable HCCA from January 2008 to October 2017. A systematic review and meta-analysis were carried out. RESULTS: Six trials were identified and included in this study. Overall, the differences in technical success rate, R0 resection, incidence of total complication after resection, postoperative hospitalization time, resection time, and recurrence were not statistically significant between the EBD group and PTBD group (all P > .05). However, the incidence of total complications after EBD treatment is higher than that after PTBD treatment (P < .05). CONCLUSION: For patients with obstructive jaundice associated with HCCA, current evidence indicate no superiority of PTBD over EBD regarding clinical feasibility and success rate, but data suggest a better clinical safety of PTBD compared with EBD in short-term postoperation. In long-term evaluation, the differences in clinical outcomes are not statistically significant between PTBD and EBD.
Subject(s)
Bile Duct Neoplasms/surgery , Drainage/methods , Endoscopy, Digestive System , Jaundice, Obstructive/surgery , Klatskin Tumor/surgery , Neoplasm Recurrence, Local , Bile Duct Neoplasms/complications , Bile Ducts, Intrahepatic/pathology , Drainage/adverse effects , Endoscopy, Digestive System/adverse effects , Humans , Jaundice, Obstructive/etiology , Klatskin Tumor/complications , Length of Stay , Neoplasm Recurrence, Local/diagnosis , Neoplasm, Residual , Operative Time , Postoperative Complications/etiology , Preoperative Care , Prognosis , Treatment OutcomeABSTRACT
AIM: To compare the clinical effectiveness of the treatment of choledocholithiasis by laparoscopic common bile duct (CBD) exploration and by endoscopic sphincterotomy (EST). MATERIALS AND METHODS: A meta-analysis of studies about CBD stones was performed to analyze EST in comparison with laparoscopic CBD exploration procedures. Trials were identified by searching the Medline, EMBASE, PubMed, CBM, and CNKI databases from January 1990 to December 2012 for laparoscopic CBD exploration or EST for CBD stones. RESULTS: Fifteen studies were identified in the meta-analysis. The incidence of bleeding or pancreatitis in the EST group was higher than that in the laparoscopic group. However, the incidence of bile leakage in the EST group was lower than that in the laparoscopic group. The differences in cases of retained stones or total complications were not statistically significant between the laparoscopic and EST groups (P>.05). There were more successful cases in the laparoscopic group than in the EST group (P<.05). Hospital cost was less in the laparoscopic group than in the EST group (P<.05). Mean operation time and hospital stay in the laparoscopic group were shorter than those in the EST group (P<.05). CONCLUSIONS: To some degree, laparoscopic treatment of the CBD may be a better way of removing stones than EST.
Subject(s)
Cholecystectomy, Laparoscopic/methods , Gallstones/surgery , Sphincterotomy, Endoscopic/methods , Anastomotic Leak/epidemiology , Anastomotic Leak/etiology , Blood Loss, Surgical/statistics & numerical data , Chi-Square Distribution , Cholecystectomy, Laparoscopic/adverse effects , Humans , Incidence , Length of Stay/economics , Operative Time , Pancreatitis/epidemiology , Pancreatitis/etiology , Sphincterotomy, Endoscopic/adverse effectsABSTRACT
This paper described a rare case of adenomyoma of common bile duct. The case is a 51-year-old man who was hospitalized for yellow color skin and sclera and itching for 2 mo without abdominal pain. Nothing special was found in physical examination except yellowish skin and sclera. The clinical presentation and Computerized Tomography (CT), Magnetic resonance cholangiopancreatography (MRCP), and ultrasonography suspected a tumor of the distal bile duct. The patient was treated successfully by pancreaticoduodenectomy. Histologically, the lesion consisted of adenoid and myofibrous tissue and moderate atypia. The immunophenotype of the epithelial component was cytokeratin 7+/cytokeratin 20-. The patient has been well without any evidence of recurrence for 12 mo since his operation.
