Effective Therapeutic Method of PTCD for Hilar Cholangiocarcinoma: A Clinical Analysis of 67 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YANGYi , JIZong-zheng , WUTao , XUXin , ZHANGXin-wu ,  CHENXi

Department of General Surgery, The Second Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China;

Corresponding author：

CHENXi, Email: 2002chenxi@163.com

Keywords：

Hilar cholangiocarcinoma; Percutaneous transhepatic choledochus drainage; Bile drainage; Radical surgery; Palliative surgery

DOI：

10.7507/1007-9424.20140069

Video：

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Objective To analyze effect of percutaneous transhepatic choledochus drainage (PTCD) for hilar cholangiocarcinoma. Methods Clinical data of 67 cases of hilar cholangiocarcinoma who treated in our hospital from Jan. 2005 to Dec. 2010 were retrospectively analyzed. Results Of the 67 cases, 30 cases were performed PTCD, 20 cases were performed radical surgery after PTCD, and 17 cases were performed palliative surgery after PTCD. There were 59 cases who were followed-up for 3-30 months, and the median time was 9.3 months. The median survival time of patients who underwent PTCD, radical surgery, and palliative surgery were 10.2, 21.4, and 8.9 months respectively. The survival of patients who underwent radical surgery was better than those of underwent PTCD (χ²=13.6, P=0.000 4) and palliative surgery (χ²=15.2, P=0.003 8), and survival of patients who underwent PTCD was better than patients underwent palliative surgery (χ²=5.3, P=0.040 1). Conclusions PTCD is contribute to preoperative diagnosis and evaluation, in addition, it can reduce unnecessary surgical exploration, guarantee the safety of the radical surgery, and provide follow-up care for palliative operation channel which is favorable for local internal radiation therapy.

Citation： YANGYi, JIZong-zheng, WUTao, XUXin, ZHANGXin-wu, CHENXi. Effective Therapeutic Method of PTCD for Hilar Cholangiocarcinoma: A Clinical Analysis of 67 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(3): 285-288. doi: 10.7507/1007-9424.20140069 Copy

1.	黄志强.肝门部胆管癌外科治疗面临的问题与出路[J].中华实验外科杂志, 2004, 21(7):773-775.
2.	黄志强.肝门部胆管癌外科治疗——我们要走向何方?[J].肝胆外科杂志, 2003, 11(5):321-322.
3.	Kondo S, Hirano S, Ambo Y, et al. Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins:results of a prospective study[J]. Ann Surg, 2004, 240(1):95-101.
4.	Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver[J]. Surg Gynecol Obstet, 1975, 140(2):170-178.
5.	周宁新.对肝门部胆管癌根治切除手术方式的改进体会[J].中国实用外科杂志, 1999, 19(10):592-594.
6.	李秋, 雷正明, 叶明新, 等.肝门部胆管癌59例外科诊治分析[J].现代预防医学, 2012, 39(10):2598-2599, 2601.
7.	胡筱壮.手术治疗高位胆管癌的临床疗效探究[J].中国医学工程, 2013, 21(10):67.
8.	李波, 严律南.肝门胆管癌的诊治进展[J].中国普外基础与临床杂志, 2005, 12(4):356-360.
9.	Huang ZQ, Zhou NX, Huang XQ. Surgical treatment o f hilar bile duct cancer:a critical review of 291 case[J]. Chinese-German J Clin Oncol, 2003, 2(2):64-71.
10.	万涛, 周宁新, 徐东刚, 等.胆管癌相关基因FXYD6的克隆及功能区定位[J].中国普外基础与临床杂志, 2010, 17(7):707-712.
11.	董家鸿, 曾永毅.梗阻性黄疸研究热点与难点[J].中国实用外科杂志, 2007, 27(10):768-770.
12.	董家鸿.胆管癌根治性手术的适应证、术式选择及远期疗效[J].中国实用外科杂志, 2001, 21(8):461-463.
13.	Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma[J]. Ann Surg, 1992, 215(1):31-38.
14.	周宁新.肝门部胆管癌(含胆囊癌)扩大根治术的范围、术式选择及评价[J].中国实用外科杂志, 2001, 21(1):18-20.
15.	周宁新, 黄志强, 张文智, 等. 402例肝门部胆管癌临床分型、手术方式与远期疗效的综合分析[J].中华外科杂志, 2006, 44(23):1599-1603.
16.	周宁新.肝门部区域解剖与病变特点对手术方式的影响[J].中国实用外科杂志, 2002, 22(7):432-433.
17.	丁义涛.胆管癌的肝移植治疗策略回顾与展望[J].器官移植, 2013, 4(2):63-67.
18.	徐川, 施海彬, 刘圣, 等.肝门部胆管癌致梗阻性黄疸介入引流治疗的预后分析[J].介入放射学杂志, 2012, 21(9):752-755.
19.	Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T, et al. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma[J]. J Gastroenterol Hepatol, 2013, 28(4):593-607.
20.	Tsao JI, Nimura Y, Kamiya J, et al. Management of hilar cholangiocarcinoma:comparison of an American and a Japanese experience[J]. Ann Surg, 2000, 232(2):166-174.
21.	石力, 汤礼军, 汪涛, 等.胆道金属支架置入治疗肝门部胆管癌的临床研究[J].中国普通外科杂志, 2012, 21(8):918-921.
22.	袁玉华, 王亚明, 王春泉, 等.术中胆道支架置入联合碘125粒子腔内照射治疗恶性胆道梗阻(附13例报告)[J].肝胆外科杂志, 2013, 21(1):54-55.
23.	施海彬, 刘圣, 王杰, 等.双途径介入治疗原发性肝癌合并梗阻性黄疸[J].介入放射学杂志, 2003, 12(5):352-354.
24.	李波, 严律南, 刘续宝. 32例肝门胆管癌的手术治疗[J].华西医学, 2003, 18(4):467-468.
25.	李波, 刘续宝, 严律南, 等. 46例肝门胆管癌的诊断和治疗[J].消化外科, 2005, 4(3):162-165.

1. 黄志强.肝门部胆管癌外科治疗面临的问题与出路[J].中华实验外科杂志, 2004, 21(7):773-775.
2. 黄志强.肝门部胆管癌外科治疗——我们要走向何方?[J].肝胆外科杂志, 2003, 11(5):321-322.
3. Kondo S, Hirano S, Ambo Y, et al. Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins:results of a prospective study[J]. Ann Surg, 2004, 240(1):95-101.
4. Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver[J]. Surg Gynecol Obstet, 1975, 140(2):170-178.
5. 周宁新.对肝门部胆管癌根治切除手术方式的改进体会[J].中国实用外科杂志, 1999, 19(10):592-594.
6. 李秋, 雷正明, 叶明新, 等.肝门部胆管癌59例外科诊治分析[J].现代预防医学, 2012, 39(10):2598-2599, 2601.
7. 胡筱壮.手术治疗高位胆管癌的临床疗效探究[J].中国医学工程, 2013, 21(10):67.
8. 李波, 严律南.肝门胆管癌的诊治进展[J].中国普外基础与临床杂志, 2005, 12(4):356-360.
9. Huang ZQ, Zhou NX, Huang XQ. Surgical treatment o f hilar bile duct cancer:a critical review of 291 case[J]. Chinese-German J Clin Oncol, 2003, 2(2):64-71.
10. 万涛, 周宁新, 徐东刚, 等.胆管癌相关基因FXYD6的克隆及功能区定位[J].中国普外基础与临床杂志, 2010, 17(7):707-712.
11. 董家鸿, 曾永毅.梗阻性黄疸研究热点与难点[J].中国实用外科杂志, 2007, 27(10):768-770.
12. 董家鸿.胆管癌根治性手术的适应证、术式选择及远期疗效[J].中国实用外科杂志, 2001, 21(8):461-463.
13. Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma[J]. Ann Surg, 1992, 215(1):31-38.
14. 周宁新.肝门部胆管癌(含胆囊癌)扩大根治术的范围、术式选择及评价[J].中国实用外科杂志, 2001, 21(1):18-20.
15. 周宁新, 黄志强, 张文智, 等. 402例肝门部胆管癌临床分型、手术方式与远期疗效的综合分析[J].中华外科杂志, 2006, 44(23):1599-1603.
16. 周宁新.肝门部区域解剖与病变特点对手术方式的影响[J].中国实用外科杂志, 2002, 22(7):432-433.
17. 丁义涛.胆管癌的肝移植治疗策略回顾与展望[J].器官移植, 2013, 4(2):63-67.
18. 徐川, 施海彬, 刘圣, 等.肝门部胆管癌致梗阻性黄疸介入引流治疗的预后分析[J].介入放射学杂志, 2012, 21(9):752-755.
19. Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T, et al. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma[J]. J Gastroenterol Hepatol, 2013, 28(4):593-607.
20. Tsao JI, Nimura Y, Kamiya J, et al. Management of hilar cholangiocarcinoma:comparison of an American and a Japanese experience[J]. Ann Surg, 2000, 232(2):166-174.
21. 石力, 汤礼军, 汪涛, 等.胆道金属支架置入治疗肝门部胆管癌的临床研究[J].中国普通外科杂志, 2012, 21(8):918-921.
22. 袁玉华, 王亚明, 王春泉, 等.术中胆道支架置入联合碘125粒子腔内照射治疗恶性胆道梗阻(附13例报告)[J].肝胆外科杂志, 2013, 21(1):54-55.
23. 施海彬, 刘圣, 王杰, 等.双途径介入治疗原发性肝癌合并梗阻性黄疸[J].介入放射学杂志, 2003, 12(5):352-354.
24. 李波, 严律南, 刘续宝. 32例肝门胆管癌的手术治疗[J].华西医学, 2003, 18(4):467-468.
25. 李波, 刘续宝, 严律南, 等. 46例肝门胆管癌的诊断和治疗[J].消化外科, 2005, 4(3):162-165.

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Effective Therapeutic Method of PTCD for Hilar Cholangiocarcinoma: A Clinical Analysis of 67 Cases

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