Surgical treatment of cholangiocarcinoma

(1) of resectability of hilar cholangiocarcinoma surgical method of choice:

① hilar bile duct, common bile duct and gallbladder removal, biliary-enteric anastomosis. Applicable to non-intrusion in real terms in the hepatic duct and liver cancer.

② liver side leaves or leaves plus part of the right anterior resection of liver and portal bile duct, extrahepatic bile duct resection and biliary-enteric anastomosis. For convergence of hepatic duct cancer or cholangiocarcinoma.

③ liver side lobe or left hepatectomy and hepatic portal bile duct, extrahepatic bile duct resection and biliary-enteric anastomosis. Applies to the left hepatic duct and liver cancer Explorer.

④ liver side lobe or right liver resection and hepatic portal bile duct, extrahepatic bile duct resection and biliary-enteric anastomosis. Explorer for right hepatic duct and liver cancer.

⑤ super-semi-liver or 3 hepatectomy and liver portal bile duct, extrahepatic bile duct, part of the caudate lobe resection, biliary-enteric anastomosis. Applies to the left or right hepatic duct carcinoma invasion and 2 above and the caudate lobe hepatic duct hepatic duct.

　　⑥Palliative resection. The liver and hepatic portal bile duct side leaves, extrahepatic bile duct resection and biliary-enteric anastomosis, and the residual part of the cancer organizations such as the caudate lobe of the hepatic duct or portal vein anterior.

⑦ portal vein, confluence, or around dry anterior resection of victims of violations of their involvement part of the vein wall re-reconstruction of vascular repair, postoperative radiotherapy supplemented by intracavitary.

(2) The interest rate for hilar cholangiocarcinoma and therefore surgery: biliary drainage is the preferred method of palliative surgery. Principle is the biliary-enteric anastomosis should be away from the lesion. According to the expansion of the bile ducts of PTC show, choose the parts of biliary-enteric anastomosis. Some cases due to violation of hilar lesions, or because of liver atrophy - Mast composite levy exists, shrinking leaf bile duct anastomosis, drainage of limited value. Mast Leaf bile duct revealed the difficulties, and many cases can not be removed only catheter drainage. Commonly used method is to place after the expansion of malignant stricture as thick and hard T-shaped tube, U-shaped tube or catheter within the support. T-tube after common bile duct or hepatic extraction can be. In order to prevent slippage, should be sutured drainage tubes fixed on the bile duct wall and around the organization, and do an upper jejunostomy for postoperative autotransfusion bile and nutrition tube feeding when necessary. Non-surgical drainage of commonly used methods PTCD, should also be placed within the expanded sinus PTCD support tube. Through the narrow segment.

(3), the lower bile duct surgery: middle and lower than the hilar bile duct carcinoma of nipple and rare. At present, most scholars of its surgical approach is the head of pancreas, duodenal resection. Those who can not be removed in the lower part of cancer that can be used these palliative approach.