Surgical Management For Bismuth â…£ Type Hilar Cholangiocarcinoma

Objectives:To discussion the impact of the different surgical management on the prognosis for hilar cholangiocarcinoma and the application of porto-enterostomy in the treatment of hilar cholangiocarcinoma.Methods:Clinical data of 17 patients with cholangiocarcinoma treated in our institute between 2005.07 and 2008.05 were investigated retrospectively.Of the 17 patients,6 underwent radical resection(radical group),7 were subjected to palliative resection treatment(palliative group) and 4 were with percutaneous transhepatic cholangic drainage(drainage group).In radical group,the patients were combined with right hepatectomy(2 cases),left hepatectomy(1 cases),part resection of portal vein(2 cases),right hepatic artery resection(2 cases),and rapid histopathological examination of resection edge proved non-cancerous cells.In palliative group,4 cases were confirmed with cancerous cells of bile duct margin post operation,the portal vein or hepatic artery were wrapped by the tumor in 2 patients,1 cases was with a number of abdominal and mesenteric lymph node metastasis. Porto-enterostomy was performed in all patients with surgical resection of the cholangiocarcinoma.Results: No one died post operation in the hospital.There was a significant difference of survival quality among three groups(F=13.21,P＜0.05).Survival quality in radical group was significantly higher than those in palliative group (t=1.83,P＜0.05) and in drainage group(t=4.76,P＜0.05).Survival quality in palliative group was significantly higher than those in drainage group (t=2.81,P＜0.05).There was also a significant difference of survival rate among three groups(x~2=27.28,p＜0.05).In radical group,the 1,2 year survival rate were significantly higher than those in palliative group(x~2=7.82,p＜0.05) and in drainage group(x~2=14.39,p＜0.05).Survival rate in palliative group was significantly higher than those in drainage group(x~2=12.57,p＜0.05).There was a significant difference of the incidence of postoperative complications among three groups(x~2=5.48,p＜0.05).There was little difference between radical group and palliative group(x~2=0.59,p＞0.05).The incidences of complications in radical group and palliative group were significantly higher than those in drainage group(x~2=5.12,p＜0.05).ConclusionRadical resection was crucial for prolonging survival time and improving life quality in patients with BismuthⅣtype hilar cholangiocarcinoma. Porto-enterostomy was effective for biliary drainage reconstruction post surgical resection of the cholangiocarcinoma.