Clinical effect of laparoscopic radical resection in treatment of type IV hilar cholangiocarcinoma

• Main Author: XU Jian
• Format: Article
• Language: zho
• Published: Editorial Department of Journal of Clinical Hepatology 2019-03-01
• Series: Linchuang Gandanbing Zazhi
• Online Access: http://www.lcgdbzz.org/qk_content.asp?id=9783

ObjectiveTo investigate the feasibility and safety of laparoscopic radical resection in the treatment of type IV hilar cholangiocarcinoma. MethodsA retrospective analysis was performed for the clinical data of 4 patients who were admitted to the Affiliated Hospital of Chuanbei Medical College from July 2015 to September 2018, underwent laparoscopic radical resection, and were diagnosed with type IV hilar cholangiocarcinoma based on postoperative pathology. There were 2 female and 2 male patients aged 53-65 years, with a mean age of 59.4 years. All patients had varying degrees of jaundice before surgery and were given symptomatic treatment including liver-protecting treatment, jaundice clearance, and nutritional support. Two patients underwent percutaneous transhepatic biliary drainage before surgery to alleviate jaundice. ResultsAll 4 patients underwent a successful laparoscopic surgery, among whom 3 underwent left hemihepatectomy+total caudate lobe resection+lymph node dissection+choledochoenterostomy, and 1 underwent extensive right hemihepatectomy+total caudate lobe resection+lymph node dissection+choledochoenterostomy. Time of operation was 5.5-8.5 hours, and intraoperative blood loss ranged from 200 to 750 ml, with 400 ml intraoperative blood transfusion in 1 patient. After surgery, 1 patient had bile leakage and was improved and discharged after conservative continuous drainage; 1 patient had massive ascites and was discharged after liver-protecting and diuretic treatment; no perioperative complication was observed in the other 2 patients. The patients were followed up for 3-24 months after surgery; 1 patient developed intrahepatic metastasis at 11 months after surgery and had survived with tumor for 4 months after interventional therapy. ConclusionWith adequate preoperative assessment, strict control of surgical indications, skilled laparoscopic technique, and standardized operation, laparoscopic radical resection is feasible and safe in the treatment of type IV hilar cholangiocarcinoma. R0 resection is an important prognostic factor.