Research On Preoperative Diagnosis Techniques Of Cholangiocarcinoma

The incidence of bile duct carcinoma (BDC) is increasing annually with low resectability, worst prognosis and generally affects aged patients in whom the use of biliary tract stent become a treatment of choice. Currently, some problems still existing in the diagnosis and treatment of BDC: (1) Imaging techniques lacked standard guidance notions. (2) Differential diagnosis of bile duct benign lesions did not get enough regards, and bile duct benign lesions were sometimes misdiagnosed and treated as BDC. (3) The placement of biliary tract metallic stent without accurate diagnosis could hide serious troubles. Therefore, research on preoperative diagnosis techniques of BDC must has important clinical value. The current studies include five parts summarized as follow:Part one: Diagnosis and differential diagnosis of carcinomas in the middle and distal part of the common bile duct Objective: To explore diagnosis and differential diagnosis of carcinoma in the middle and distal bile duct. Methods: We performed a retrospective study of 21 patients with carcinomas in the middle and distal part of common bile duct carcinomas (confirmed diagnosis group, CDG) and 18 cases misdiagnosed as bile duct carcinomas (misdiagnosis group, MG). Results: Most of patients in the two groups presented distension in the upper abdominal region, painless jaundice, fever and lost of weight. 78.9% of cases in CDG and 33% of cases in MG presented CA19-9 serum level higher than the normal. The accuracy rates of Ultrasound B, CT and ERCP in CDG were 47.6%, 55.5% and 87.5% respectively. In CDM, preoperative imaging techniques accurately shown stenosis of bile duct, including ERCP n=9, MRCP n=6, PTC, trough T tube cholangiography and CT n=1 respectively. The post-operative diaognosis of 16 cases were: common bile duct (CBD) injury n=3, cholecystolithiasis with cystic duct and common bile duct confluence excessively low n=2, metastasic lesion of carcinoma of gallbladder n=2, pancreaticcarcinoma n=2, pancreatic tuberculosis n=2, and chronic pancreatitis, CBD stone, ampullar carcinoma, duodenal carcinoma, abdominal cavity tuberculosis n=1 respectively. One abdominal cavity tuberculosis and one sclerosing cholangitis were diagnosed after treatment and surveillance. Conclusions: Preoperative diagnosis and differential diagnosis of carcinomas in the middle and distal part of bile duct based on stenosis of bile duct by imaging techniques is unaccurate. Further methods have to be taken to improve the accuracy of preoperative diagnosis.Key words: Bile Duct Carcinoma;Neoplasms;Imaging...