Diagnosis, Treatment And Prognosis Analysis Of Bismuth-Corlette Type Ⅰ And Type Ⅱ Hilar Cholangiocarcinoma

Objective:To explore the diagnosis, the curative effect of surgical treatment and factors affecting the prognosis of Bismuth-Corlette type I and type II hilar cholangiocarcinoma. Methods:The clinical data and follow-up results of 47 cases of Bismuth-Corlette type I and type II hilar cholangiocarcinoma treated in Shanxi Dayi Hospital and First Hospital of Shanxi Medical University from January, 2007 to January, 2014 were analyzed retrospectively. Relevant prognosis factors were also analyzed. Results:47 cases were included in this group. 39 cases underwent b- ultrasonic examination, positive for 29 cases(74.4%); 38 cases underwent C T examination, positive for 32 cases(84.2%), and 38 cases underwent MRCP examination, positive for 37 cases(97.4%). Among them, 31 cases received radical resection, 12 cases palliative resection, and 3 cases single drainage. 43 cases accepted follow-up, and the follow- up rate was 91.5%. The survival rate of all the patients 1 year, 3 years and 5 years after surgery was 74.4 %(32/43), 36.6%(15/41) and 22.5%(9/40), and the median survival time was 26.3 months. The survival rate of radical resection group 1 year, 3 years and 5 years after surgery was 85.7%(24/28), 48.1%(13/27) and 33.3%(9/27), and the median survival time was 34.2 months; the survival rate of palliative resection group 1 year, 3 years and 5 years after surgery was respectively 63.6%(7/11),20%(2/10) and 0%, and the median survival time was17.3 months; the survival rate of drainage group 1 year, 3 years and 5 years after surgery was respectively 25%(1/4), 0% and 0%, and the median survival time was7.8 months. Difference of each group’s median survival time had statistical significance(χ2=20.634, P=0.000<0.05). The single factor analysis of affecting prognosis showed that the median survival time of lymph node metastasis positive and negative was respectively 11.2months and 43.1 months, and difference of the two group’s postoperative median survival time had statistical significance(χ2=21.444,P=0.000<0.05). While the difference of age, Bismuth classification, neural invasion, pathological types and other factor analysis, all had no statistical significance. 9 cases occurred complications, and the incidence rate was 19.1%. Among them, there were 2 cases with liver function failure, 5 cases with biliary fistula, 1 case with pulmonary infection and 1 case with incision liquefaction. Among the 9 cases, 1 case, due to liver function failure, died in 2.1 months after surgery, and the rest all left hospital after conservative treatment. Conclusions:Early symptoms of Bismuth-Corlette type I and type II hilar cholangiocarcinoma aren’t typical, mainly based on imaging diagnosis, in which the positive rate of MRCP diagnosis is the highest. Radical resection is still the top choice of treatment for Bismuth-Corlette type I and type II hilar cholangiocarcinom, and for patient who cannot be treated radically, palliative resection can also obtain certain curative effects. Radical resection and lymph node metastasis are important factors affecting the postoperative survival of Bismuth-Corlette type I and type II hilar cholangiocarcinoma.