Clinical Application Study On Double Interventional Therapy In The Treatment Of Hilar Cholangiocarcinoma

Hilar cholangiocarcinoma, or proximal bile duct carcinoma(PBDC), is defined as tumor originated from the common hepatic duct, left and right hepatic duct and the confluence. As the most common type of extrahepatic duct cancer, it takes up to 45－60％ of all the extrahepatic duct cancer .However, the prognosis of this kind of disease is the poorest and the therapeutic approach is the most difficult and debating. In the 1970's , it was regarded as an "forbidden zone" for attempt of surgical resection. From the 1980's,with the much progress in the modern imaging diagnostic methods and surgical techniques, the preoperative diagnostic rate is apparently increased and most patients could be correctly diagnosed before surgery. The survival rate and life quality after surgical resection improved a lot. However, until recent years, the detailed preoperative assessment and proper surgical intervention for hilar cholangiocarcinoma are still challenging. The more invasive diagnostic method not only help people to investigate the invasiveness of tumor but also hurt the patients, delay or eliminate the opportunity for potentially tumor resection. Up till now, the therapeutic guidelines are still not fully established. Preoperative biliary depression is still under debating. Although it has been widely accepted that radical resection may achieve superior therapeutic effects and represent the only "curative" option for this kind of disease. However, due to various factors, most patients are in advanced stage when a hepatobiliary specialist is summoned which seriously impact the resection rate. The postoperative complications are common. For unresectable patients, there are many options for palliative drainage procedures, however, the effectiveness is not satisfactory and postoperative complication is not uncommon.There are also some patients subjected for endoscopic bile duct drainage(endoporosis). This is the lest invasive method nowadays, however, the therapeutic effects are not satisfactory too and may affect the chance for curative resection. Therefore, the proper management for hilar cholangiocarcinoma is still a great challenge for hepatobiliary specialist.PURPOSE1. To summarize the experiences of preoperative assessment and proper surgical approach for hilar cholangiocarcinoma.2. To found out the best guideline for preoperative diagnosis and surgical treatment of hilar cholangiocarcinoma.3. To analyze the factors affecting postoperative morbidity rate and survival time after surgery, explore the ways to improve therapeutic effect of surgical intervention. Material and MethodWe collect 56 cases of primary hilar cholangiocarcinoma treated surgically in our hospital from Jan. 1991 to Oct 1998, the intahepatic cholangiocarcinoma, gallbladder carcinoma and patients treated by non-surgical procedure such as PTCD or endoprostheses were excluded from this study. The male to female ratio is 2.5:1 and average age was 58 years old (range: 36 to 90). We retrospective collected and analyzed the following data: (1) Clinical presentations, laboratory examinations, including liver function test, blood routine and biochemical substances; (2) Preoperative imaging diagnosis, including sonography, CT, PTC, MRCP, et al. The cases, diagnosis result and the description of the foci; (3) Operation record, including procedure, exploration result, description of incised specimen; (4) Postoperative complications, including the occurrence time, countermeasure and outcome; (5) Death within 30 days after surgery. Follow-up data of the patients survived after surgery was collected via mailing of questionnaires, telephone talking, and out-patients-department visiting. The general condition, elimination of jaundice, frequency of cholangitis, recurrence dates and the cause and date of death were recorded. All data collected was analyzed by SPSS for Windows Version 8.0 software in a Pentium class, IBM-compatible computer. The Chi-Square Test or Independent-Sample T Test were used for the compare of rate or means betwe...