Surgical Treatment of Bile Duct Cancer at Hepatic Hilum:A Clinical Analysis of 60 Cases

The incidence of bile duct cancer at hepatic hilum has a tendency toincrease in recent years.This paper is to report 60 cases during a10-year-period from 1975 to 1985.The cancer at the hepatic hilum(60 cases)made up 73％ of all extrahepatic bile duct cancers(82 cases),and accounted for1.65％ of 3626 biliary operations done at the same period.The clintcalmanifestations of the patients could be categorized into three types,the presentingsymptoms were obstructive jaundice in 29 cases,of which 25 had beenmisdiagnosed as infectious hepatitis;the symptoms of acute cholangitis were foundin 12 cases;and in 14 cases,various symptoms and signs of biliary diseases hadbeen found for a long time before the diagnosis was established as cancer.In theremaining 5 cases,miscellaneous manifestaions were revealed.The patients wereexamined with B- US(19 cases),ERCP(10 cases)and PTC(39 cases).The finaldiagnosis was established according to the findings of PTC and/or ERCP,surgical exploration,or histopathological examination.Surgery was performed on56 cases.Only 6 out of the 56 received radical resection of the cancer withhemi-hepatectomy;palliative internal drainage of the bile duct was done on 15cases,external drainage on 23 cases,and other palliative measures on 12 cases.The average survival time after operation was 24.5 months in 6 cases with radicalresection,8.7 months in 48 cases with palliative measures,and only 5 months in 4cases without surgical intervention.Early diagnosis is imperative if successfultherapy is expected.It is suggested that a patient over 40 years of age,sufferingfrom“infectious hepatitis”or obstructive jaundice,be watched out for thepossibility of hilum cancer,and appropriate examinations such as B-US,CT,ERCP or PTC be carried out.It is emphasized that PTC plays an important rolein the diagnosis of hilum cancer.In severe cases,the intrahepatic bile ducts couldbe examined with PTC of the two sides at one time.Exploratory laparotomyshould be performed on suspected cases.

Surgical Treatment of Bile Duct Cancer at Hepatic Hilum:A Clinical Analysis of 60 Cases