Study on variou operations and prognosis extrahepatic bile duct cance

AIMS To evaluate clinically the surgical procedures and their in- fluence on the prognosis of extrahepatic bile duct cancer. METHODS A total of 55 patients with pathologically and clini- cally verified extrahepatic bile duct cancer treated in our depart- ment between January 1984 and December 1993 were retrospec- tively analyzed.Clinical courses with respect to the surgical pro- cedures employed and the survival period of these patients were followed up and compared. RESLUTS Of these patients,24 involved the upper third of ex- trahepatic biliary tract,12 the middle third,and 19 the lower third.Diagnosis of bile duct cancer was confirmed histopatholo- gically in 42 patients,with a clear predominance of adenocarcino- ma(97.6 percent).Eleven(26.2 percent)patients received cu- rative resection;30 received palliative procedures,i.e.,biliary- enteric bypass(n=14)and external drainage(n=16);6 re- ceived permanent PTCD alone and 8 received exploratory laparo- tomy only or conservative treatment.Forty-eight patients(87.3 percent)were followedup.The overall mean survival period was 10.8±9.7months(±s);patients with curative resection had the longest survival period(21.4±16.7 months,±s,P<0. 01)and highest survival rate(P<0.05);a significant survival difference was observed in patients with biliary-enteric anastomo- sis compared with those with external drainage,ect.(P<0. 05);but there was no significant difference in survival period be- tween patients having PTCD(n=23)and not(n=26)prior to surgery(P>0.05). CONCLUSIONS Curactive resection is the treatment of choice for suitable patients with extrahepatic bile duct cancer;biliary-en- teric anastomosis is preferable in those with unresectable tumor in order to improve the prognosis and quality of life.

Detection of hepatitis C virus NS5 protein and genome in Chinese carcinoma of the extrahepatic bile duct and its significance

AIM To investigate the hepatitis C virus(HCV)infection in the tissues of carcinoma ofextrahepatic bile duct and study theircorrelation.METHODS HCV NS5 protein and HCV RNA weredetected by labeled streptavidin biotin(LSAB)method and in situ reverse transcriptionpolymerase chain reaction(IS-RT-PCR)insections of 51 cases of carcinoma ofextrahepatic bile duct and 34 cases of controlgroup(without malignant biliary disease).RESULTS In 51 cases of carcinoma ofextrahepatic bile duct,HCV NS5 protein wasdetected in 14(27.5%),which was clearlystained in the cytoplasm of cancer cell but not inthe nucleus or cell membrane.HCV RNA wasdetected in 18(35.4%),which was located inthe nucleus of cancer cell in 12 cases and in thecytoplasm in 6 cases.HCV NS5 protein and RNAcoexistence was found in 2 cases.In 34 cases ofcontrol group,HCV RNA was detected in 2(5.9%).HCV NS5 protein and RNA positive cellswere found either scattered or in clusters.CONCLUSION The prevalence of hepatitis C viral infection in the tissues of carcinoma ofextrahepatic bile duct was significantly higherthan in control group(X^2=9.808,P=0.002).The findings suggest a correlation between HCVinfection and carcinoma of extrahepatic bileduct,which is different from the traditionalviewpoint.HCV infection might be involved inthe development of carcinoma of extrahepaticbile duct.

Diagnosis and surgical treatment of hepatic hilar cholangiocarcinoma

BACKGROUND: Hepatic hilar cholangiocarcinoma can be diagnosed early with the progress in diagnostic imaging, and thus the rate of resection of the tumor has increased markedly. To assess the effectiveness of resection, we reviewed 185 cases of hepatic hilar cholangiocarcinoma diagnosed and treated at our hospital. METHODS: The clinical data of 185 patients with hepatic hilar cholangiocarcinoma who had been treated surgically from 1972 to 2006 were retrospectively analyzed. RESULTS: The records of the 185 patients were divided into first stage (1972-1986) or second stage (1987-2006) according to the incidence of the tumor and its resection rate. Primary symptoms included upper abdominal discomfort or pain, anorexia, tiredness, weight loss and progressive jaundice. Ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP) were first line methods for atraumatic diagnosis. If the patients displayed intrahepatic bile duct dilatation or were diagnosed as suffering from extrahepatic obstructive jaundice, percutaneous transhepatic cholangiography (PTC), MRCP or endoscopic retrograde cholangiopancreatography (ERCP) should be used. In this series, 87 patients underwent resection of the tumor (47.0%). Of the 87 patients, 43 received radical resection and 44 palliative resection. Fifteen patients underwent resection in the first stage and 72 in the second stage. A total of 74 patients were followed up after the resection. The median survival time of the radical resection group was 37 months and that of the palliative resection group was 17 months (P<0.001). The other 62 patients receiving no resection died within 1.5 years. CONCLUSIONS: Once patients are diagnosed with hepatic hilar cholangiocarcinoma, they should undergo exploratory laparotomy. Resection is the most effective method for the treatment of hepatic hilar cholangiocarcinoma.

Changing trends of surgical treatment of hilar bile duct cancer:clinical and experimental perspectives

HISTORICAL POINT OF VIEWCarcinoma of the confluence of the hepatic ductshas been thought to be a rare disease until recently.Carcinoma of the large hepatic ducts was rarelydiagnosed correctly premorterned.Because of itsdeeply seated location,resection was once thoughtto be impossible.In 1957,Altemeier reported

Role of serum total sialic acid in differentiating cholangiocarcinoma from hepatocellular carcinoma

AIM:This study was designed to evaluate the clinical application of serum total sialic acid (TSA) in the diagnosis of cholangiocarcinoma (CCA).METHODS: Serum TSA was determined by periodateresorcinol microassay in 69 patients with CCA, 59 patients with hepatocellular carcinoma (HCC), 37 patients with cirrhosis, 61 patients with chronic hepatitis and 50 healthy blood donors.RESULTS: The mean serum TSA concentration in CCA (2.41±0.70 mmol/L) was significantly higher than those of HCC, cirrhosis, chronic hepatitis and healthy blood donors (1.41±0.37 mmol/L, 1.13±0.31 mmol/L, 1.16±0.26 mmol/L, and 1.10±0.14 mmol/L, respectively; P＜0.001). Based on ROC curve analysis, a cut-off point of 1.75 mmol/L discriminated between CCA and HCC with a sensitivity,specificity and accuracy of 82.6%, 83.1%, and 82.8%,respectively.CONCLUSION: Based on our results, serum TSA would be a useful marker for the differential diagnosis of CCA from HCC.

EXPRESSION OF X-GENE TRANSLATION PRODUCT IN HUMAN PRIMARY CHOLANGIOCARCINOMA AND ITS SURROUNDING NONTUMOROUS TISSUES

Intrahepatic cholangiocarcinoma is an uncommon type of primary hepatoma and its mechanism is still unknown. Twenty samples of the cancer and the tissues surrounding it were all taken from the Xi' an area and examined for the presence of X-gene product (HBxAg) by the avldin-biotin-peroxidase complex method. It was found that 17 cases (85%) showed positive reaction, HBxAg was present in 15 cancer samples and 16 non-tumor tissue samples. This result suggests that there is a close relationship between human choiangiocarcinoma and HBV, and the HBxAg might play an important role in the pathogenesis of cholanglocarcinoma.

Localization of X-gene translation product in human cholangiocarcinoma and its surrounding liver tissues

Intrahepatic cholangiocarcinoma is an uncommon type of primary hepatomaand its mechanism is still unknown.Twenty samples of the cancer and the surrounding tis-sues were all taken from the Xi’an area and examined for the presence of X-gene prod-uct(HBxAg)by the avidin-biotin-peroxidase complex method.It was found that 17 cases(85%)showed positive reaction,HBxAg was present in 15 cancer samples and 16non-tumor tissue samples.This result suggests that there is a close relationshipbetween human cholangiocarcinoma and HBV,and the HBxAg might play an importantrole in the pathogenesis of cholangiocarcinoma.

肝门部胆管癌外科治疗20年经验回顾

目的 总结 2 0年肝门部胆管癌外科治疗的经验 ,探讨提高切除率 ,减少并发症的有效措施。方法 回顾总结 1978年 1月～ 1997年 12月西南医院外科治疗 2 0 1例肝门部胆管癌的临床资料 ,以 1991年为界限前后分为两个阶段以对照手术切除率、并发症及死亡率等。结果 2 0 1例中手术切除 97例 ,非切除行胆道内、外引流者 84例 ,单纯剖腹探查 2 0例。切除组中根治切除 5 1例 ,姑息切除 46例。随访 75例中 ,根治切除者 1,3,5年生存率分别为95 45 %,40 91%,13 6 4%;姑息切除者 1,3年生存率为 5 5 %,10 %,无 5年生存者 ;非切除性胆道内、外引流者 1年生存率为 36 %,无 3年生存者 ;单纯剖腹探查者均于 3个月内死亡。两个阶段对照显示 :手术切除率由 1990年 12月以前的 34 95 %提高到以后的6 2 2 4%,其中根治切除率由 15 5 3%提高到 35 71%;手术并发症及死亡率分别由 39 8%和 17 84%降低到 18 37%和 6 12 %。结论 根治切除是提高肝门部胆管癌远期存活率的关键 ,合理的围手术期处理可降低手术并发症发生率及死亡率。

肝内胆管结石合并肝胆管癌:附24例报告

目的探讨肝内胆管结石与肝胆管癌发生的关系及提高早期诊断的措施。方法回顾性分析近2 0年收治的2 4例肝内胆管结石并发肝胆管癌患者的临床资料。结果肝内胆管结石并肝内胆管肿瘤在所有肝内胆管结石的病例中占2.8%(2 4/8 6 0),癌肿均发生于含结石胆管处,部分切片中可见癌与不同程度的胆管上皮不典型增生同时存在。术前B超、CT和MR I/MPCP对肝内胆管结石并发肝占位病变诊断率分别为4 0.9%(9/2 2),5 3.8%(7/1 3)和6 6.7%(4/6);手术切除率70.8%(1 7/2 4),根治性切除率为3 3.3%(8/2 4)例,姑息切除率为3 7.5%(9/2 4)。术后1,3年生存率:根治组为6 2.5%,2 5.0%,姑息性组为3 3.3%,1 1.1%,活检组为0%。结论长期肝内胆管结石反复发作是引起胆管癌发生的重要原因;结石型肝内胆管癌的延误诊断率高、根治性切除率低、预后差。重视结石型肝胆管癌临床延误诊断的原因并采取相应的避免措施有助于早期诊断。

联合肝叶和肝门血管切除治疗肝门胆管癌

目的 探讨治疗肝门胆管癌理想的肝叶切除术式 ,以期提高其疗效、降低并发症和病死率。方法 对 16例侵犯肝门血管的肝门胆管癌 ,采用肝I ,IV段连同肝门胆管肿瘤与受侵血管整块切除及肝十二指肠韧带骨骼化淋巴清扫。结果 15例获手术切除 ,切除率为 93 .8% ,12例获R0 切除。无手术死亡和住院死亡。发生暂时性胆漏 1例 ,腹腔感染 1例 ,并发症发生率为 13 .3 % ,均行非手术治愈。随访病例中位生存期为 2 2个月 ,7例尚存活。结论 合并肝叶、肝门血管切除可提高肝门胆管癌的切除率和生存率 ;肝中叶和肝尾叶是肝门胆管癌手术联合切除的主要部位。肝门受侵血管的切除对提高该病切除率和根治率是有意义的 ,应酌情重建或不重建肝门血管。

肝门部胆管癌的手术治疗:附102例报告

目的探讨肝门部胆管癌的手术治疗方式。方法回顾性分析1 9 9 0年8月—2 0 0 3年8月我院收治的1 0 2例肝门部胆管癌的临床资料。结果1 0 2例肝门部胆管癌中,5 8例(5 6.9%)行手术切除,其中2 7例(2 6.5%)行根治性切除,3 1例(3 0.4%)行姑息性切除;4 4例(4 3.1%)行胆管引流术,其中行胆肠吻合内引流术2 0例,胆管外引流术2 4例。根治性切除术组1,2,3,5年生存率分别为8 8.8 9%,5 1.8 5%,3 7.0 3%,2 2.2 2%;姑息性切除术组1,2,3,5年生存率分别为51.61%,6.4 5%,3.2 2%,0%;胆肠吻合内引流术组和胆管外引流术组的1年生存率分别是29.41%和2 3.8 0%,无生存2年者。结论手术切除,特别是根治性切除治疗肝门部胆管癌可取得较好的疗效。

合金胆道支架治疗不能切除的恶性肿瘤所致的梗阻性黄疸

目的 探讨镍钛记忆合金胆道支架治疗不能切除的恶性梗阻性黄疸的价值和适应证。方法 回顾性分析笔者治疗的 15例恶性梗阻性黄疸的临床资料 ,其中胆管癌 8例 ,胆囊癌 3例 ,胰腺癌 2例 ,胃癌根治术后肝门转移癌 2例 ,均置入合金胆道支架。结果 放置支架后 11～ 3 8d黄疸消退 ;1例放射介入方法置入支架第 3天出现胆道出血 ,经非手术方法治愈。无手术死亡。全部病例定期随访。术后生存 3 0～ 3 84(平均 180 .5 )d。结论 对不能切除的恶性梗阻性黄疸置入镍钛合金胆道支架 ,操作较简单 ,痛苦较少 ,并发症较少 ,减黄效果满意 ,是一种较为理想的姑息性疗法。

肝门部胆管癌手术治疗:附64例报告

目的探讨肝门部胆管癌手术方式。方法回顾性分析15年间我院收治的64例肝门部胆管癌的临床资料,包括临床表现、临床分型、手术方式及治疗效果。其中35例行手术切除,包括根治性切除16例,姑息性切除19例;29例行胆管引流术,包括胆肠内引流术16例,胆管外引流术13例。结果根治性切除组1,2,3年生存率分别是80.0%,53.3%及26.7%;姑息切除组1,2,3年生存率分别为50.0%,16.7%,0%;胆肠内引流组1,2年生存率分别是45.5%和18.2%;外引流组则为25.0%和0。结论手术切除特别是根治性切除治疗是提高肝门部胆管癌疗效和提高远期生存率可选择的方法。

肝外胆管癌的诊治

目的 总结肝外胆管癌的诊断及手术治疗方法。方法 回顾性分析 1972年～1999年收治肝外胆管癌 10 0例的临床资料 ,其中上、中、下及全段胆管癌分别为 6 8,12 ,18及 2例。结果 首发症状为上腹不适隐痛、腹胀、乏力 ,明显消瘦及进行性黄疸等。B超、CT或MRI是无损伤的诊断方法 ,若显示肝内胆管扩张或诊断肝外梗阻性黄疸 ,则应进一步行PTC(本组 13例 )或ERCP(本组 42例 )。根据肿瘤所在部位及肝门部胆管癌的分型 ,选择不同的手术方式 :上段手术切除 2 5例 (36 8% ) ,其中Ⅰ型行胆管癌局部或“骨骼化”切除 15例 ,Ⅱ型行胆管癌切除加尾叶切除 9例 ,Ⅲb型行胆管癌切除加尾叶及左三叶切除 1例 ;中段手术切除 9例 (75 % ) ;下段行胰十二指肠切除 14例 (77 8% )。上、中段均行胆管空肠Roux en Y型吻合胆道重建术。本组总切除率为 48%。有 35例得到随访 ,5年生存率为 5 8%。未切除者 5 2例中有 32例得到随访 ,均于 1～ 1 5年死亡。结论 B超、CT及MRI是早期诊断肝外胆管癌的首选方法 ,必要时选用PTC或ERCP对进一步诊断更有价值。手术切除是治疗肝外胆管癌最有效的手段。

肝门部胆管癌外科治疗的临床与实验研究

肝管汇合部癌曾一直被认为是一少见病,患者生前很少能确诊.由于其位置深在,曾以为不可能手术切除.Altemeier et al1957年报告3例主要肝管的硬化型癌,其中1例在3 a 时间内曾手术7次而未得到确诊,直至最后肝门发生腺癌转移才明确诊断。

远端胆管癌外科治疗的效果分析

目的 探讨远端胆管癌外科治疗的并发症、术后生存率及其相关因素。方法 回顾性分析我科 12年间外科治疗的 2 3例远端胆管癌患者的临床资料。结果 出现手术并发症的患者其术前症状持续的时间 ( 0 .5 0± 0 .18)个月显著短于无手术并发症的患者 ( 1.2 9± 0 .2 3 )个月 (P <0 .0 5 )。总体术后中位时间生存 18( 1～ 70 )个月 ,17例 ( 73 .9% )生存 1年以上 ,5例 ( 2 1.7% )生存 3年以上 ,2例 ( 8.7% )生存 5年或 5年以上。是否行根治性切除、手术时是否出现远处转移与术后生存率显著相关 (P <0 .0 5 )。结论 首发症状持续时间可能和外科治疗后并发症发生率有关。胰十二指肠切除是治疗远端胆管癌的有效手段。手术时出现远处转移者预后较差。

肝胆管囊腺瘤和囊腺癌诊治7例

目的:探讨肝胆管囊腺瘤和囊腺癌临床特征、诊断方法及外科治疗.方法:回顾性分析2003-02/2007-02中国医科大学附属第一临床医院收治的肝胆管囊腺瘤患者3例及肝胆管囊腺癌4例的临床资料.结果:肝胆管囊腺瘤3例均为女性,右上腹部隐痛不适,剑突下疼痛和腹胀.肿瘤标志物CA19-9升高(2/3),AFP无升高,肝脏囊性占位性病变,伴有分隔以及钙化影,平均最大直径17cm.术后随访26mo,未见复发.肝胆管囊腺癌4例,男性1例,女性3例,右上腹部隐痛和腹胀.肿瘤标志物CA19-9升高(2/4),AFP无升高,肝脏的囊性占位性病变伴有不规则分隔外,囊壁结节以及乳头状突起,平均最大直径13cm.其中3例行根治性切除术,已随访12mo,无复发或转移.结论:肝胆管囊腺瘤和囊腺癌早期诊断困难,肿瘤标志物及影像学检查有助于其诊断和鉴别,手术切除为最有效的治疗手段.

先天性胆管囊肿内引流术后胆管癌:附25例报告

目的 探讨先天性胆管囊肿内引流术后癌变及其手术处理原则。方法 对 1970～ 1996年间收治的先天性胆管囊肿行内引流术的 82例患者进行随访 ,并对其中术后 2 5例癌变患者的临床资料进行分析。结果 本组先天性胆管囊肿内引流术后癌变率为 3 0 .49%( 2 5 /82 ) ,其中囊肿十二指肠吻合术后癌变率为 3 5 .2 9%( 14 /5 1) ,囊肿空肠Roux en Y吻合术后癌变率为 2 2 .5 8%( 11/3 1)。 2 5例中 3例行胰十二指肠切除术 ,4例行肿瘤切除胆道重建术 ,4例行局部病灶切除外引流术 ,14例肿瘤广泛转移无法切除仅行外引流术。结论 囊肿内引流术后癌变率高 ,应该摒弃该术式。

联合尾叶的规则性肝叶切除术治疗肝门部胆管癌

目的探讨如何提高肝门部胆管癌根治性切除率和生存率的方法。方法回顾性分析8年余收治的58例肝门部胆管癌行联合尾叶和规则性肝叶切除术患者的临床资料。结果肿瘤切除联合行规则性左半肝切除26例,规则性右半肝切除25例,右三肝切除4例,中肝叶切除3例;所有患者同时附加全尾叶切除手术和肝十二指肠韧带淋巴结骨骼化清扫。根治性切除率为72.4%(42/58)。1,3年生存率分别为79.5%和36.2%。有3例现已无瘤存活6年。结论肿瘤切除联合尾叶的规则性肝叶切除可以提高肝门部胆管癌根治性切除率和术后生存率;熟练掌握手术技巧是关键。

Bismuth Ⅳ型肝门部胆管癌的外科治疗

目的探讨BismuthⅣ型肝门部胆管癌的外科治疗方法。方法对近5年来经手术和病理确诊的22例BismuthⅣ型肝门部胆管癌患者的临床资料进行回顾性分析。结果22例患者中,男13例,女9例,男女之比1.4∶1。常规手术方法治疗16例(常规手术治疗组),包括手术切除5例(31.3%),其中根治性切除2例,姑息切除3例;内或外引流术11例。经典式原位肝移植术6例(肝移植组)。常规手术方法治疗组1,2年累积生存率分别为32.1%,0;肝移植组除1例术后11个月死于慢性排异反应外,余均健康存活,现已分别存活28,19,17,12个月和9个月,未见肿瘤复发和转移,术后1,2年累积生存率分别为80.0%(4/5),50.0%(1/2)。两组生存率比较差异有显著性(P=0.041)。结论BismuthⅣ型肝门部胆管癌应行积极的外科治疗,其中根治性切除术是提高患者存活率的关健;常规手术无法根治切除者是原位肝移植的适应证,术后疗效满意。