SURGICAL TREATMENT OF HILAR BILE DUCT CARCINOMA

From June, 1986 to June 1989, 24 cases of hilar bile duct carcinoma were explored in the Surgical Department of General Hospital of PLA, 16/24 cases were resected, a resectability rate of 66%. The increase of resectability rate was due to earlier recognition of this condition and the extension of surgery, including major resection of liver as well as radical dissection of the hepato-duodenal ligament and repairative operations on the blood vessels. Among these 16 cases, major hepatic resection was performed in 10 cases, in which, 3 cases of resections of the middle lobe of the liver were done instead of right or extended right lobectomy. No operative mortality in the 30 days' postoperative period, but the postoperative morbidity rate was still high and most of the complications were related to biliary leakage and infection. Three patients died in the follow up period at 6, 14 and 15 months respectively. All of them died from biliary infection. The remaining 13 patients were still alive, the longest being 40 months and the average living time was 16.1 months. Probably, lowering of the operative mortality rate and morbidity rate are still the most important considerations in the surgical treatment of hilar carcinoma at the present time. Extensive liver resection especially on the right side, carried a high mortality rate in the deeply jaundiced patients. We considered that preoperative PTCD was of much less value than that used in lower bile duct obstruction such as tumors of the periampullary region. Preservation of the superior and posterior portion of the right lobe of the liver may be of advantages as to lowering postoperative hepatic failure and infection of the right subphrenic space as observed in this series of cases.

Reliability of the Estimation of the Take of Split Thickness Graft by the Observation Method

Introduction: Split thickness skin grafts are frequently employed to provide biological cover for extensive wounds. The take of the skin graft is traditionally estimated by observation and recorded as a percentage. The intent of this study was to ascertain the reliability of the observation method in comparison with the Image J digital programme. Materials and Methods: The study was a longitudinal study conducted on the wards of the National Reconstructive Plastic Surgery and Burns Centre (NRPSBC) at the Korle Bu Teaching Hospital (KBTH) on patients who were admitted during the period of the study with wounds who received split skin grafts. Image J®, an image analysis program, was employed in the calculation of the take of the grafts. These were compared to values obtained by estimation by observation. Results: There was no statistically significant difference between the estimation of graft take, made by observation and using Image J® digital programme. Conclusion: The estimation of graft take by observation is an acceptable practice.