Objective To explore whether the intraoperative cholangiography （IOC） should be applied in laparoscopic cholecystectomy routinely or selectively. Methods Data of routine IOC group （1 520 patients）and selective IOC group （457 patients）in laparoscopic cholecystectomy were collected and analyzed， including cholangiography time， success rate， common bile duct stones rate， open cholecystectomy rate， and hospital stay after operation. All IOC cases were performed by home-made cholangiography appliance or infusion needle. Results There were no significant differences between routine IOC group and selective IOC group on cholangiography time， success rate， open cholecystectomy rate， and hospital stay after operation （P＞0.05）. However， compared with routine IOC group， the common bile duct stones rate， anatomic variation rate， and iatrogenic damage rate were significantly higher in selective IOC group （28.25% vs. 13.43%， 10.71% vs. 7.43%， 2.05% vs. 1.02%， P＜0.05）. Conclusions For avoiding iatrogenic bile duct damage and residual stones， routine IOC should be applied in early-stage of laparoscopic cholecystectomy， and IOC should be applied selectively when the surgeon have LC technique at their finger ends.
Objective To summarize the multi disciplinary team (MDT) discussion in the treatment of intrahepatic cholangiocarcinoma (ICC) involving inferior vena cava (IVC). Method The clinical data of a difficult ICC patient diagnosed and treated in Gansu Provincial Hospital in September 2020 were analyzed retrospectively, and the clinical features, diagnosis, treatment decision and prognosis of ICC were summarized. Results The patient was initially diagnosed as liver malignant tumor, which invaded the right adrenal gland and inferior vena cava. After MDT discussion, the patient decided to undergo surgical treatment, and successfully underwent radical resection of liver tumor combined with right adrenal gland and partial inferior vena cava and vascular reconstruction. The operation lasted 300 minutes, and the intraoperative bleeding was about 600 mL. The results of postoperative pathological examination indicated that it conformed to ICC, and carcinomatous tissues involvement could be seen in inferior vena cava and adrenal gland. The patient had no complication after operation and was discharged from hospital at 2 weeks after operation. The patient had been followed up for half a year and had been regularly treated with gemcitabine combined with platinum for 6 phases. No tumor recurrence or metastasis had been found. Conclusions The onset of ICC is concealed and its invasiveness is strong. The preliminary diagnosis can be determined by imaging examination combined with detection of tumor markers. Radical surgery is the main treatment. After MDT discussion, the formulation of a comprehensive treatment plan, including surgical strategy, local treatment and systemic treatment, can improve the prognosis and prolong the survival time of patients.