Surgical Treatment Of Hilar Cholangiocarcinoma

Objective:To discuss the diagnosis and surgical treatment of Hilar Cholangiocarci-noma and further inhance the understanding of this disease.Methods:The diagnostic criterion of Hilar Cholangiocarcinoma was imaging diagnosis before operation or made a definite diagnosis by exploratory operation but diagnosed as the jaundice block before operation. Including 23 males,12 females, the rate was 1.9:1,36-79 years old, the mean age was 57 years old. No patients complained of serious cardial, pulmonary and nephric pathological changes. All of these patients included Bismuth-Corlette type I in 17 cases, typeâ…¡in 5 cases, typeâ…¢a in 1 case, typeâ…¢b in 4 cases, typeâ…£in 7 cases and no Bismuth-Corlette type in 1 case. All the patients acquired resections, amoing which 7 had hepatectomy combined with (3 had wedgeshaped resected the tissue at the hepatic portal,2 had resected the left and caudate lobe,1 had resected the left lobe,l had wedgeshaped resected the right lobe and the left branch of portal veins),25 had local resected (extrahepatic bile duct resection),10 were radical excision and 15 were palliation,3 had palliative external drainage,3 had laparotomy.Results:29 patients which were acquired the pathological records were diagnosed as adenocarcinoma, among which 9 were of high differentiation,15 were of low differentiation,1 was of undifferentiation,2 were of mucinous adenocarcinoma; the assay index of liver function showed great improvement after operation. Complication took place in 6 cases (17.1%), of which 3 cases with bile leakage,1 case with hemorrhage,1 case with wound infection,1 case died. All the patients were cured after 2-3 weeks treatment except the case of death. The median length of hospital stay was 24 days after operation,8 cases were more than 30 days. The case which Hilar Cholangiocarcinoma can not be cut and internal and external drainage can not be accomplished died of multiple organ failure caused by hepatic failure in 1 day after surgial explorated was Bismuth-Corlette type IV.Conclusion:1 To enhance the understanding and redouble our vigilance of Hilar Cholangiocarcinoma, the patients with obstructive jaundice should be examined by B-ultrasund, then combined with MRCP or CT, we can define the diagnosis and evaluation for resectability of Hilar Cholangiocarcinoma.2 we should have a positive attitude towards the operation of Hilar Cholangiocarcinoma, hepatectomy combined with could improve the radical resection rate, palliative external drainage could apply to the patients inoperation. The liver function showed great improvement after operation.3 The proper prevention and treatment of the postoperation complications of the patients with Hilar Cholangiocarcinoma could improve their survival rate and therapeutic effect.