| Objective：Explore the perihiliar cholangiocarcinoma after surgical treatment ofclinical curative effect and prognosis factors, summarizes the experience ofdiagnosis and treatment of perihiliar cholangiocarcinoma, provide a bettersolution for patients with individualized treatment.Methods:A retrospective analysis of the Fist Hospital of Jilin Universityhepatobiliary pancreatic surgery department form2008to2014in patients withperihilar cholangiocarcinoma were case80cases,who were ready to surgery,related to clinical data, including patient history, biochemical indicators inpatients with preoperative, tumor markers, tumor classification, operationmethod, the pathological results and prognosis for sorting, motion is analyzed bySPSS software for data.Results:1. The perihilar cholangcarcinoma in the elderly, can do is focused on thesurgical treatment of patients with age55to60years old.For progression ofobstructive jaundice patients should consider the disease may be; they have longbile duct stones, cholangitis should be alert to the disease; Patients with common bile duct cyst should be closely monitored.2. Auxiliary examination: alanine aminotransferase positive rate91.25%;aspartateaminotransferase positive rate88.75%; alkaline phosphatase positiverate of91.25%; γ-glutamyl transferase-positive rate of97.5%; positive rate of95percent of total bilirubin; direct bilirubin positive rate of98.75%. The CA19-9positive rate of88.75%, CEA positive41.25%. B type ultrasound examinationin80cases, the positive rate of42.5%; CT examination78cases, the positive rateof83.78%; MRI examination in25cases, the positive rate of86.21%.3. Operation method: the experiments,43radical resection (53.75%),16palliative resection (20%),21cases of gallbladder excision plus internal orexternal drainage (26.25%).4. Pathology results: pathological examination of69cases,bile ductcarcinoma68cases, including3cases of well-differentiated adenocarcinomas,5cases of moderately-well differentiated adenocarcinomas, moderately different-iated adenocarcinoma in37cases, moderately-poorly differentiated adenocarci-noma in12case,2cases of poorly differentiated adenocarcinoma; adeno-squamous carcinoma in1case.2cases occurred regional lymph node metastasis.5. Postoperative complications:1case due to radical resection of hilarcholangiocarcinoma (including removal of the right liver), patients hadabdominal infection, infection of diaphragmatic under, in the hospital for a longtime;4cases with bile leakage;incision infection in3cases. Patients weredischarged from hospital after treatment to improve. 6. This group of80cases of data in the experiments, the radical resectiongroup was1year,2years,3years survival rate was74.42%,50%,33.33%,palliative resection group was1year,2years,3years survival rate was56.25%,30.77%,11.11%, drainage of the gallbladder excision plus inside or outside1year,2years,3year survival rate was52.39%,13.33%,0.Conclusion:1. The perihilar cholangcarcinoma in the elderly, progression of obstructivejaundice patients should consider the disease, patients with chronic calculousand cholangitis should be vigilant, and patients with common bile duct cystdisease should be timely check.2. Laboratory examination to the perilihilar cholangiocarcinoma, there is noclear indicators, joint CA19-9and CEA examination is helpful to improve thediagnosis of perilihilar cholangiocarcinoma, at the same time can also be sidecan prompt perihilar cholangiocarcinoma radical resection;Joint CT and MRIimaging examination, we advocate for hepatic bile duct cancer screening, notonly can observe the morphological characteristics of tumor, as well as thetumor invasion and blood vessels, the bile duct and the surrounding soft tissueshave cognitive from multiple perspectives.3. Radical resection is the first selection of hepatic bile duct carcinomatreatment portal vein, is also the key factor for patients with long-term survival,the application of various drainage method can quickly relieve obstruction inpatients with symptoms, improve liver function. |
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