| Background Hilar cholangiocarcinoma ia a kind of malignant tumor origin form the bile duct epithelial cells.Hilar cholangiocarcinoma is often diagnosed late with a poor prognosis. To get a radical resection, combined liver excision is an essential procedure,however this procedure increases the risk of postoperative hepatic failure, infection, etc. Due to severe jaundice, many elderly patients can’t tolerate the trauma of radical surgery. As an important adjuvant treatment, because of the advantages such as little trauma, safe, effective, the role of the 1125 particles implantation has been widely used in the treatment of a variety of solid tumors, and is gradually applied in clinical treatment of hepatic bile duct carcinoma. Objective to explore the safety,effectiveness and feasibility of an new surgical method to treat those hilar cholangiocarcinoma patients who can’t tolerate a wide range of liver resection. This method combined simple hepatic bile duct carcinoma resection, bile duct jejunum Roux en-Y anastomosis. Discusses the use of 1125 particles embeddedauxiliary liver door liver tissues in the treatment of bile duct carcinoma.Methods a retrospective collection, analysis, liver and gallbladder surgery in 2008-2014 in henan province people’s hospital surgical treatment of the hepatic portal vein of patients with bile duct cancer, screening in standard cases, according to whether the porta hepatic tissues around puncture group cases implanted radioactive 1125 particles divided into combined treatment group (n= 37) and simple surgical group (n= 33). Comparative analysis of liver function, complications, such as the preoperative data, the hepatic artery, portal vein invasion and other intraoperative situation, the bile duct branch cut edge is negative, tumor pathological type, lymph node metastasis of postoperative pathological data, perioperative complications, mortality data and time recurrent jaundice and the survival time of postoperative follow-up data.Results a total of 70 patients were included in the study, comprehensive treatment group (37 cases and simple surgical group 33 cases. Implanted an average of 27.8 I125 particles in comprehensive treatment group (14-25), the comprehensive treatment group in the left hepatic duct postoperative cut edge RO resection rate were 78.4%, bile duct right cut edge RO resection rate were 34.7%, bile duct incised edge RO resection rate 94.6%, average cleaning the lymph node number 7.8, lymph node positive rate was 34.6%. Simple surgical postoperative left hepatic duct RO resection rate were 78.8%, bile duct right cut edge RO resection rate were 42.4%, bile duct incised edge RO resection rate 97.0%, average 8.1, cleaning the lymph node positive rate was 36.3%. The above data no statistical difference between the two groups. Incidence of bile leakage comprehensive treatment group was 13.5%, pure scores bile leakage rate was 15.1%, the whole group had no life-threatening complications. Comprehensive treatment group without jaundice survival time is 15.3 months on average, the median surial for 18 months,1 year,2 years,3 years survival rates were 73.3%,54.6% and 30.7% respectively. Contrast the treatment group without jaundice survival time is 11.6 months on average, the median survival period for 14 months,1 year, 2 years,3 years survival rates were 63.9%,34.8% and 14.2% respectively. The log-rank test ana lysis showed that the comprehensive treatment group than control group survival rate have significant difference.Conclusion simple hepatic bile duct carcinoma,1125 particle placement in porta hepatic tissues, bile duct jejunum Roux en-Y anastomosis in patients with specific adaptation is a safe and effective method. Compared with simple hepatic resection in patients with bile duct carcinoma,1125 particle placement in porta hepatic tissues help to prevent patients postoperatively in patients with jaundice, prolong survival time and improve life treatment has a significant role. |
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