Carcinoma of the extrahepatic bile ducts

Thirty-seven patients with carcinoma of the extrahepatic bile ducts (EHBD), diagnosed over 14 years from 1974 to 1987, were studied retrospectively. The most common presenting complaint was jaundice, followed by abdominal pain, nausea and vomiting, and weight loss. The majority of EHBD carcinomas were located at the middle third of the bile duct (43.2%), followed by upper third bile duct (37.8%), and lower third bile duct (18.9%). The resectability of the surgically managed group was 44.4%. The most common histologic type was adenocarcinoma. The 30-day postoperative mortality was 30.6%. The mean overall survival of the patients with EHBD carcinoma was 11.2 months. Patients with distal third tumors had the best prognosis with a mean overall survival of 16.0 months. The mean overall survival of patients with upper-third and middle-third tumors were 10.9 months and 9.4 months. A high index of suspicion of the disease as well as earlier, aggressive surgery may improve patient survival.     

A Study of Malignant Bile Duct Stenosis Using Percutaneous Transhepatic Cholangioscopy

Abstract: From June, 1987 to November, 1989, 11 patients with malignant bile duct stenosis, which was later confirmed by surgery or autopsy, were examined by percutaneous transhepatic cholangioscopy (PTCS) and by an endoscopic biopsy. The endoscopic findings obtained with the usual observation methods and methylene blue staining and the histological findings of the biopsy specimens were compared. A fine vascular proliferation was seen in all of the patients and a granular appearance was noted in patients with carcinoma of the major papilla. The papillary appearance was noted in one case each of pancreatic carcinoma, bile duct carcinoma and carcinoma of the major papilla. Marginal protrusion was not noted in patients with pancreatic carcinoma. A distorted narrow segment was seen only in cases of pancreatic carcinoma. The presence of a granular appearance indicated that the carcinoma was exposed on the surface. A high degree of fine vascular proliferation and a papillary appearance tended to indicate a carcinoma which invaded mainly into the fibromuscular layer without invasion of the mucosa. The methylene blue staining method was simple and effective for better visualization of the surface structure of the abnormal area, normal mucosa and the border zone.     

肝内胆管主支与肝表面距离的测量

在30个成人肝脏的剥离标本上,测量了肝内胆管主支与肝表面的距离。为经皮肝穿刺胆道造影术提供解剖学依据。     

The use of lasers in the treatment of cholangiocarcinoma

Summary Six of seven patients were treated with external beam radiation, iridium-192 internal radiation and neodymium-YAG laser therapy via a percutaneous transhepatic tract for relief of biliary obstruction. After laser therapy, the transhepatic catheters were removed and patients remained tube-free and non-jaundiced for periods ranging from 1 to 20 months.Presented at the International Congress on Surgical Endoscopy, Ultrasound and Interventional Techniques, Berlin 1988     

Extension of hepatic matastatic tumor along a biliary drainage catheter tract: Case report

Extension of hepatic metastatic tumor along a biliary drainage catheter tract is an unusual occurrence. We believe this is the first report of such a case presenting as a calcified, subcutaneous mass at the catheter entry site.     

原发性肝癌肝动脉化疗碘油栓塞后的MRI诊断价值

目的 研究MRI检查技术，尤其是FSET2WI和多时相快速动态增强扫描评价原发性肝癌动脉化疗碘油栓塞后（TACE）的影像学表现，探讨其临床应用价值。方法收集2000年9月至2004年7月肝癌病例30例（共37个病灶），于TACE后2～6个月行GE1．5TMRI检查，并于MRI检查后2～6d行DSA检查。研究肝癌TACE后肿瘤的坏死或存活的MRI信号特点，以及MRI和DSA在显示肿瘤存活结果的符合情况。结果37个肝癌TACE术后病灶中，MRI明确判断21个病灶有肿瘤残存，16个病灶凝固坏死明显。MRI判断病灶残存的敏感性为91．3％，特异性100％，准确性94．6％。与DSA相比无明显统计学差异（P〉0．05）。结论FSET2WI和多时相快速动态增强扫描序列相结合，同时观察病灶周围的完整与否，可以准确地判断肝癌TACE后肿瘤的坏死或残存。作为一种无创伤性检查。可以作为评价肝癌TACE术后疗效的首选检查。     

Experience with percutaneous transhepatic cholangiography using the Japanese needle

Percutaneous transhepatic cholangiography using a very thin needle has been performed in 885 patients with a variety of underlying hepatic, biliary, and pancreatic disorders. The procedure was successful in 99% of the patients with dilated intrahepatic bile ducts and in 85% of those with non-dilated ducts. Complications which required surgical intervention occurred only in two cases (0.2%). In patients with obstructive jaundice, external bile drainage was performed immediately after visualization of the bile duct. Percutaneous transhepatic cholangiography is an extremely useful and safe method for investigating disorders of the biliary tract, for localizing the cause of obstructive jaundice, and for reducing the degree of jaundice and improving the general status of patients with obstructive jaundice.     

TACE、PEI、PVC介入三联疗法治疗中晚期肝癌

目的研究TACE、PEI、PVC介入三联疗法治疗原发性肝癌的疗效。方法(1)TACESeldinger′s法,5F导管、高选择、造影到位后注入5Fu1g、MMC10mg、ADM或EADM50～60mg与40%碘化油10～20mL的混合乳化剂。隔1～1.5月可重复;(2)PEICT引导下18GPTC穿剌针穿入肿瘤碘油缺损区,注入无水酒精2～8mL或10～20mL,1～2次/周,4～6次为1疗程;(3)PVCPEI后1～2周,在B超引导下用18G中心静脉导管穿剌针到门静脉穿剌,留置中心静脉导管或植入药盒,1次注入MMC6～8mg,药泵持续5d灌注5Fu2.5～3g。可隔3～4周后重复给药。结果本组14例,病灶缩小率为71.4%,AFP下降占85.7%;半年生存率为78.6%,1年生存率为57.1%,2年生存率为28.6%。结论介入三联疗法对不能手术切除,尤其对门静脉癌栓或门静脉供血的肝癌有较好的疗效,具优势互补作用。