Treatment and operation of hilar cholangiocarcinoma 1;
Because the tumor of hilar cholangiocarcinoma is located at the entrance of the liver, that is, at the hilum, it is difficult to achieve radical surgical treatment and needs to be removed together with the hilum. It is easy to bleed heavily during operation, and it is difficult to ensure the residual liver function during operation. A little carelessness will lead to postoperative complications such as biliary fistula and liver failure, which is life-threatening.
Therefore, radical surgery is rarely performed in the treatment of hilar cholangiocarcinoma, and only palliative local resection can be achieved. In recent years, with the in-depth study of hilar anatomy, the scope of surgical resection has been continuously expanded. The resection rate of hilar cholangiocarcinoma has been continuously improved through additional lobectomy and reconstruction of hilar vessels.
In the treatment of hilar cholangiocarcinoma, it is very important to correctly evaluate the infiltration of important blood vessels and bile ducts in hilar region before operation. If a correct preoperative evaluation can be made, unnecessary surgical exploration can be avoided, and the pain of patients can be alleviated, which is beneficial to the operation of hilar cholangiocarcinoma. Evaluation methods include ultrasound, CT, MRCP, ERCP, PTC and angiography.
Radical resection includes extrahepatic biliary tract resection, vascularization on hepatoduodenal ligament, extensive resection of fibrous adipose tissue, nerve and lymph on hepatoduodenal ligament, resection of a liver lobe if necessary and reconstruction of hepatojejunostomy. Most hilar cholangiocarcinomas have caudate lobe infiltration, and those who invade the confluence or the left and right hepatic ducts must remove the caudate lobe.
Most scholars believe that active hepatectomy can improve the prognosis on the basis of correctly estimating the degree of invasion.
Palliative treatment includes percutaneous, endoscopic or surgical bypass catheter drainage and biliary stent implantation, aiming at alleviating jaundice and preventing or treating complications such as itching, abscess and liver failure. Methods of placing biliary stent include percutaneous transhepatic biliary puncture (PTD), duodenoscopy (ERCP), laparotomy and interventional therapy via external drainage tube.
2, radiotherapy and chemotherapy:
Hilar cholangiocarcinoma is not sensitive to chemotherapy and radiotherapy, so chemotherapy and radiotherapy are rarely used for the treatment of hilar cholangiocarcinoma, and are usually only used for palliative treatment of patients with hilar cholangiocarcinoma who are already highly malignant and cannot be surgically removed. Because radiotherapy and chemotherapy will cause certain harm to human body, the treatment of hilar cholangiocarcinoma should be combined with traditional Chinese medicine in order to achieve the effect of synergy and attenuation.
3. TCM treatment of liver:
Chinese medicine is also an important method for the treatment of hilar cholangiocarcinoma. Because surgery, radiotherapy and chemotherapy are not prominent in the treatment of cholangiocarcinoma, and will cause damage to human function, traditional Chinese medicine can enhance the therapeutic effect of western medicine on the one hand, and reduce the toxic and side effects of western medicine on this cancer on the other hand, with definite curative effect.
Traditional Chinese medicine believes that the occurrence of hilar cholangiocarcinoma is related to overeating, stagnation of liver-qi and weakness of spleen-qi, and should be attacked and supplemented simultaneously, which has a positive effect on inhibiting hilar cholangiocarcinoma cells, improving immunity and improving quality of life.
For the postoperative treatment of patients with hilar cholangiocarcinoma, Chinese medicine can treat them according to different conditions, such as surgical trauma, organ function loss, loss of qi, blood and body fluid, etc., so as to improve human immune function and accelerate the recovery of the body, which has a good long-term effect on the treatment of hilar cholangiocarcinoma; For patients who can't be treated surgically, such as advanced hilar cholangiocarcinoma or metastatic cancer, Chinese medicine should be given priority to in the treatment of cancer, which can inhibit the development of cancer, improve survival treatment and prolong survival time.
Staging of hilar cholangiocarcinoma
Type ⅰ tumor is located at the bifurcation of the common hepatic duct, connecting the left and right hepatic ducts. Type ⅱ tumor occupies the junction of left and right hepatic ducts, and there is no passage between them. Type ⅲ tumor invaded one hepatic duct, type ⅲ a invaded the right hepatic duct, and type ⅲ b invaded the left hepatic duct. Type ⅳ tumor involves two hepatic ducts.
Clinically, according to the invasion degree of tumor to hepatic artery and portal vein, the course of cholangiocarcinoma can be divided into four stages. Stage ⅰ: the tumor was confined in bile duct, and no portal vein and hepatic artery were invaded; Stage Ⅱ: The tumor involved unilateral portal vein and hepatic artery; Stage ⅲ a: the tumor involved one branch of hepatic artery and portal vein; Stage ⅲ b: the tumor involved one side of portal vein and proper hepatic artery; Stage ⅳ: The tumor involved the proper hepatic artery and portal vein branches.
Diagnosis of hilar cholangiocarcinoma
The classic diagnosis mode of hilar cholangiocarcinoma is: jaundice+intrahepatic bile duct dilatation+normal extrahepatic bile duct diameter+gallbladder emptiness+space occupying lesion in hilar region. The diagnosis is not difficult, but it is mostly in the middle and late stages. If we can make a diagnosis before jaundice appears, it will be of positive significance to improve the resection cure rate.