Surgical treatment of proximal bile duct tumors

A new classification of proximal bile duct tumors mainly based on endo- and exobiliary neoplastic invasion, indicating radical or palliative surgery is proposed. Fifty-eight patients underwent radical (12) or palliative (46) surgery. The 5-year survival rate of patients treated radically is 40% compared to 0% in patients treated palliatively; all the patients of this latter group died within 22 months. The authors stress the need for a standard anatomical classification for proximal bile duct tumors.     

Surgical treatment of cholangiocellular carcinoma and proximal bile duct tumors

According to its different location, clinical features, treatment modalities and prognosis, intrahepatic cholangiocarcinoma should be well differentiated from proximal bile duct carcinoma. There is no therapeutic measure with curative potential apart from surgical treatment. Partial or extended hepatectomy is the treatment of choice in cholangiocarcinoma. Thereby, hilar resection in combination with hepatectomy is increasingly performed in proximal bile duct carcinomas. In most centers liver transplantation is not considered as a therapeutic option for irresectable cholangiocarcinomas.     

Surgical management of proximal bile duct cancers

INTRODUCTION: Tumors arising from the proximal biliary tree remain particularly challenging with respect to their evaluation and treatment. Complete resection with negative histologic margins is the most effective treatment modality. RESULTS: However, the majority of patients are not candidates for surgery. Over the last decades, advances have evolved to improve resectability and morbidity after major liver and bile duct resection. However, these disease processes still pose a management challenge. Herein, we provide an overview of proximal bile duct cancers, hilar cholangiocarcinoma (HCCa) and intrahepatic cholangiocarcinoma (ICCa).     

Surgical management and outcome of bile duct injuries following cholecystectomy: a single-center experience

Purpose  

Biliary injury is a severe complication of cholecystectomy. The Hepp–Couinaud reconstruction with the hepatic duct confluence and the left duct may offer best long-term outcome as long as the confluence remains intact (Bismuth I–III). Complex liver surgery is usually indicated in most proximal (Bismuth IV) injuries in non-cirrhotic patients. The aim of this study was to evaluate the surgical treatment and outcome of bile duct injuries managed in a referral hepatobiliary unit.     

Surgical treatment of iatrogenic lesions of the proximal common bile duct

Between January 1979 and September 1999 a series of 96 patients were operated on at our institution for iatrogenic biliary injuries, and among them 62 involved the proximal biliary tract. Injuries, according to the Strasberg classification, were type E2 in 18 patients, type E3 in 29 patients, and type E4 in 15 patients. The most frequent primary surgical procedures were laparoscopic cholecystectomy in 27 of the 62 patients (43.6%) and open cholecystectomy in 30 patients (48.3%). Previous repair had been attempted in 25 patients (40.3%). A total of 58 cholangiojejunostomies were performed. Repair had been performed directly, and a T-tube had been left in the main bile duct in four patients with E2 Strasberg lesions. Postoperative death occurred in four patients (6.4%). Outcome was graded as excellent, good, or poor depending on clinical symptoms, liver function tests, and the need for reintervention due to anastomotic stricture. The final outcome was evaluated in 54 patients. The mean follow-up was 5.9 ± 0.3 years, with the longest follow-up 10.2 years. Following our first repair 49 of the 54 patients (90.7%) had excellent results, 1 (1.9%) had good results, and 4 (7.4%) had poor results. None of the patients who underwent immediate or early repair had complications. Diagnostic and therapeutic courses are given on the basis of the type of lesion and the timing of repair. We emphasize the importance of timing (i.e., carrying out surgical repair as soon as possible) and of cholangiojejunostomy reconstruction in respect to defined technical principles. Moreover, we believe that repair treatment at a hepatobiliary center with multidisciplinary competence greatly influences the final long-term outcome.     

预防腹腔镜胆囊切除术中胆管损伤的单中心经验

目的 探讨联合胆囊管解剖特点与围胆囊三角区分离预防腹腔镜胆囊切除术中胆管损伤的临床应用价值.方法 回顾分析西南医科大学附属中医医院肝胆外科2005年1月至2020年01月开展的9460例LC术的临床资料.结果 本组共开展9460例LC术,全组病例术中均无肝外主要胆管损伤.术后出现并发症18例,其中2005年1月至201...     

胆管壁坏死的手术处理

目的 探讨胆管壁坏死外科手术处理.方法 回顾性分析了1990年5月至2008年12月收治的94例胆管壁坏死病人的临床资料.结果 无手术病死、无胆瘘、大出血等严重并发症.结论 根据胆管壁坏死的特点采用相应的手术方式.

Abstract：

Objective To explore the surgical treatment of bile duct necrosis.Methods Clinical data of 94 cases of bile duct necrosis treated in this hospital from May1990 to December 2008 were retrospectively analyzed.Results There were no death or severe complications such as biliary fistula and massive hemorrhage in these patients.Conclusion Bile duct necrosis should be treated with a proper surgical approach based on its features.     

胆管损伤的外科处理

胆管损伤的治疗一直是胆道外科的重要课题.胆管损伤若处理不当,可继发胆管狭窄和复发性胆管炎,远期可导致胆汁性肝硬化和门静脉高压,患者将陷于无尽的痛苦之中.患者常需反复进行胆道狭窄修复手术,成为胆道外科最棘手的难题之一.分析我们治疗的近三百例胆道损伤性狭窄病例提示,原先处理失败的原因大多数与胆道损伤后再次手术时机不合适,治疗未遵循胆道外科原则,手术方法选择不当,或未重视胆道重建的技术细节等因素有关.本文就上述这几个方面,结合我们的临床经验,对损伤性胆管狭窄的外科处理进行探讨.     

Surgical treatment of lithiasis of the common bile duct: our experience

On the basis of their personal experience of biliary pathology, the authors present their opinion of surgical treatment of benign diseases of the common bile duct. From 1980 to 1988 a total of 930 patients were assessed, 140 of whom were affected by choledocholithiasis. Data confirmed that, with the exception of choledochotomy as a direct approach for removing stones, good results were achieved using papillosphincterotomy, since this technique best restores the physiology of the biliary tract. In cases where common duct dilation exceeded 20 mm or where the patient was in poor clinical condition, bile was drained into the gut forming a side-to-side choledochoduodenostomy.     

原发性肝癌伴胆管癌栓的手术处理七例报告

目的总结外科手术治疗原发性肝癌合并胆管癌栓的方法及要点。方法本组肝癌切除后,自肝断面胆管残端清除癌栓;胆总管切开取出癌栓并与肝断面上的胆管“会师”。结果随访１年,健在６例,死亡１例。结论肝癌切除加胆管癌栓清除术对伴发胆管癌栓的原发性肝癌不失为一种积极有效的治疗方法     

高位胆管损伤性狭窄的外科处理

由于外伤、医疗相关操作或其他任何原因破坏了胆道系统的完整性和通畅性,即为胆管损伤.当这种损伤发生在左、右肝管汇合部或以上引起胆管狭窄,称为高位胆管损伤性狭窄.由于其位置深、解剖复杂,且常由于经历过手术治疗,局部粘连严重,外科处理时需要一定的技术和经验.     

肝细胞性肝癌伴胆管癌栓的手术治疗

2004年1月至12月在第二军医大学东方肝胆外科医院行手术治疗的肝细胞性肝癌(以下简称肝癌)伴胆管癌栓21例,现报告如下. 临床资料     

Surgical treatment of hilar bile duct carcinoma

Carcinoma of the bile duct at the hepatic hilar region is not a rare condition but with a low resectability rate. The incidence of this disease seems to be on increasing. In a previous report, 60 cases were explored surgically from 1975 to 1985, but resection was only possible in 5 cases (9.1%); while in the recent years from June, 1986 to June 1989, 24 cases were explored in the Surgical Department of General Hospital of PLA, 16 cases were resected, with 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 reparative 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 infect ion. Three patients died in the postoperative follow up period at 6.14 and 15 months respectively. All of them died from biliary infection. The remaining 13 patients were still living, 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.(ABSTRACT TRUNCATED AT 250 WORDS)     

Surgical management of proximal bile duct cancer: extended right lobe resection increases resectability and radicality

Background: Surgical resection provides the only chance of cure for patients suffering from hilar cholangiocarcinoma. Although appropriate procedures are not agreed upon, an increase in radicality has been observed during the past 20 years.Methods: The literature as well as our own experience after 133 resections of hilar cholangiocarcinomas were reviewed.Results: Tumor-free margins represent the most important prognostic parameter. Hilar resections as least radical resective procedure will generate rates of formally curative resections of less than 50%. Even after these formally curative resections, long-term survival cannot be achieved. Only additional liver resections will increase the number of long-term survivors to significant figures. In our series, the best 5-year survival rate of 72% was achieved after right trisegmentectomy with concomitant resection of the portal vein bifurcation.Conclusion: Right trisegmentectomy and combined portal vein resection represent the best way to comply with basic rules of surgical oncology for hilar cholangiocarcinoma. This procedure will provide the most pronounced benefit among various types of liver resection, whereas local resections of the extrahepatic bile duct must be considered as an oncologically inefficient procedure.     

成人先天性胆管扩张症的外科治疗

先天性胆管扩张症(bile duct dilatation,BDD)是一种以胆管扩张和胰管-胆管合流异常为特征的胆道疾病,通常在儿童期发病,但也有少部分患者病情迁延至成年.而成人型BDD的病程长,合并症多,部分患者往往接受多次不恰当手术[1].本研究回顾性分析2000年1月至2010年12月昆明医科大学第一附属医院收治的76例行手术治疗的成人BDD患者的临床资料,旨在探讨其外科治疗方法及疗效.