The Analysis Of Diagnosis And Therapy Of 190 Cases Of Cholangiocarcinoma

Objective: Cholangiocarcinoma is a primary malignancy which originates from the left and right hepatic duct to the lower end of biliary tract. Cholangiocarcinoma is frequently diagnosed at an advanced stage of the disease and its prognosis is usually poor for the lower radical excision rate, high surgical postoperative complications and high mortality. This article summarizes the clinical manifestations by analyzing 190 cases of Cholangiocarcinoma, and analyses the difference of diagnosis and treatment among the different types, analyses the efficacy of surgical treatment.Methods: A retrospective analysis was made on 190 patients with cholangiocarcinoma admitted between January 1st 1999 and December 31st 2008 to The Hepatobiliary department of The First Affiliated Hospital of Chongqing Medical University. There were 115 subjects in whom cholangiocarcinoma was located at hilar bile duct, 12 in whom it was found in the middle of the bile duct, and 62 in whom it was present at the distal end of bile duct. Hilar bile duct cancer can be divided into 4 types according to Bismuth-Corlette classification: Typeâ… , Typeâ…¡, Typeâ…¢and Typeâ…£. Typeâ…¢is further divided intoâ…¢a andâ…¢b. The subjects were classified as follows Typeâ… - 10 subjects , Typeâ…¡-12 subjects, Typeâ…¢a 14 subjects, Typeâ…¢b 18 subjects, and Typeâ…£- 30 subjects. There were 31 cases which could not be classified precisely.The data was analyzed according to bile duct region it was found in - the hilar bile duct cancer, middle and distal bile duct cancer, age, sex, blood type, hemoglobin, liver function tests, imaging and pathological diagnosis. It was then compared for any significant differences. The treatment options of the 3 types Cholangiocarcinomas were summarized and the difference of the rate of radical resection was compared. The prognosis of both radical and non radical resection were assessed according to the follow up data.Results: There was no significant difference among the upper, middle and lower bile duct cancer in sex, age, blood type, hemoglobin, TB, DB, ALB, ALT, AST, and ALP. For the diagnosis of cholangiocarcinoma, Contrast-enhanced CT was better than Sonography(P=0.026),MRI and MRCP were better than Sonography(P=0.000),And MRI and MRCP were better than Contrast-enhanced CT(P=0.009). There was no significant difference among the pathological diagnosis of the three types (P=0.088). The rates of radical resection for the three types also did not show any significant difference (P=0.324).After radical resection 1-year, 3-year, 5-year survival rate were significantly higher than non-radical resection and non-surgical group (P = 0.000, 0.000).Conclusions: The clinical manifestations of Cholangiocarcinoma were non-specific, the diagnosis of Cholangiocarcinoma was mainly based on the imaging examination. There were no differences among the hilar bile duct cancer, middle bile duct cancer and distal bile duct cancer. Radical resection can increase the survival rate of cholangiocarcinoma.