Clinical Analysis Of 75 Cases Of Bile Duct Carcinoma In The Middle And Lower Segment

Objectives:Summary of the clinical features of middle and distal bile duct cancer patients, study of tumor markers, ultrasound, enhanced CT and MRI/MRCP and ERCP in diagnosis of middle and distal bile duct cancer, to explore the operation mode of the middle and distal bile duct cancer, by operation and pathological examination results of tumor staging and transfer way.Methods:Retrospective analysis in Kunming Medical University the Second Affiliated Hospital of hepatobiliary surgery treated by pathological diagnosis of 75 cases of middle and distal bile duct cancer and analysis the clinical manifestations, tumor markers (CEA, CA199, CA50 and CA242), image examination, treatment methods and postoperative complications of treatment, postoperative pathological results of clinical data and statistical analysis was carried out between January 2008 January 2016.Results:In the middle and distal bile duct cancer 64% occurred in 50-70 years old, more common in men.The symptoms of jaundice, skin itching, fever and anorexia weak clay defecate color no statistical significance (P> 0.05) in middle and distal bile duct carcinoma, but abdominal pain more common in middle segment of the bile duct carcinoma (P< 0.05).CA199 was more sensitive than CEA, CA50, and CA242 (P<0.05) in the diagnosis of bile duct carcinoma in the lower and middle section.Compared with MRI/MRCP and CT, the accuracy of the former was higher than that of the latter, and the misdiagnosis rate was lower than that of the latter, and the difference was statistically significant (P<0.05).There was no significant difference in the diagnostic rates of biopsy and MRI/MRCP for the lower and middle bile duct cancer (P> 0.05) in ERCP.There was no difference in the postoperative complications and mortality of the patients with bile duct carcinoma in the lower part of the pancreatic head and duodenum (P> 0.05).69 adenocarcinoma patients with poorly differentiated adenocarcinoma accounted for 58%, which was more than high differentiation and moderately differentiated adenocarcinoma (P<0.05).The study group of distal bile duct carcinoma invading the most tissues and organs followed by bile duct, pancreas, peripancreatic lymph nodes, the duodenal wall, nerve, violations of duodenal papilla, infiltration of the bile duct wall fat around the lymph, portal vein, gall bladder, liver, middle segment of the bile duct carcinoma with invasion of most tissues and organs followed by bile duct wall, nerve, infiltrating duct lymph fat, pancreas, next to the wall of the duodenum, proper hepatic artery lymph node, liver, peripancreatic lymph node metastasis, gallbladder, portal vein.Conclusions:1. In the middle and lower part of bile duct cancer is more common in men,50-70 years old is the peak of the incidence, male female ratio 1.59:1. Lower segment of the bile duct cancer patients with 78.6%III, IV stage, middle bile duct carcinoma in 88% of patients for the III, IV, in patients with multi is advanced, but the radical surgical resection rate was 74.7%,5 year survival rate was 29.4%, we should actively consider the operation treatment.2. CA199 was more sensitive than CEA, CA50 and CA242 in the diagnosis of bile duct cancer in the middle and lower part of the. MRI/MRCP in the middle and lower part of the bile duct cancer diagnosis rate is better than B ultrasound and enhanced CT, the three joint detection can significantly improve the diagnostic rate. Biopsy under ERCP is similar to MRI/MRCP in the diagnosis of the biopsy, but there are serious complications, which should be avoided in the diagnosis of ERCP.3. Middle and lower segment of the bile duct cancer patients do pancreatic duodenal resection. After external drainage of bile after jaundice symptoms improved, TBIL, DBIL, ALT, AST in vitro bile drainage has improved significantly, but of operative time, bleeding volume, postoperative complications and mortality rate had no effect.4. In the middle and lower part of bile duct carcinoma,92%were adenocarcinoma, 58%poorly differentiated adenocarcinoma.Low differentiated adenocarcinoma is common in the middle and lower part of bile duct adenocarcinoma.5. Distal bile duct cancer violated most of the tissues and organs are in turn bile duct, pancreas, peripancreatic lymph nodes, the duodenal wall, nerve, duodenal papilla, next to the bile duct wall surrounding lymph fat and hepatic artery lymph node, gallbladder, portal vein, liver. The middle bile duct cancer violated most of the tissues and organs followed by bile duct wall, nerve, bile duct wall surrounding lymph fat, pancreas, next to the wall of the duodenum, proper hepatic artery lymph node, liver, peripancreatic lymph node metastasis, gallbladder, portal vein.