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Reconstructive Surgeries of Cholangiocarcinoma
( Valeriy Boyko ),( Yuriy Avdosyev ),( Anastasiia Sochnieva ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: A great number of post-operative complications and high mortality accompanies reconstructive surgeries of cholangiocarcinomas. The development of irreversible hepatic decompensation in the post-operative period becomes the main cause of unsatisfactory treatment outcomes. Methods: Treatment outcomes for 22 patients with cholangiocarcinomas were analyzed. All patients underwent reconstructive surgeries. The amount and type of operative treatment depended on the extent, localization of the tumor, and the Bismuth-Corlette classification. Results: Pre-operative preparation in the form of biliary decompression was performed through percutaneous transhepatic biliary drainage (PTBD) in 11 (50%) patients (target group) and other 11 (50%) (reference group) patients were operated without biliary decompression. Isolated resections of bile ducts were performed in type I and II tumors in 10 (45.5%) patients, right-side and left-side hemihepatectomy with total caudal lobectomy in 3 (13.6%) and 2 (9.1%) cases in patients with type IIIA and IIIB tumors in both groups. Biliodigestive junction performed in 6 (27.3%). Postoperative complications were observed in 2 (18.2%) patients of target group and 3 (27.3%) of reference group: hepatic failure in 1 (9,1%) patients of target group and 2 (18.2%) of reference group, septic cholangitis in 1 (9.1%) patient of reference group, hepaticojejunostomic leakage in 1 (9.1%) patients of target group. Mortality in target group was 9.1% (1 case), in reference group was 18.2% (2 cases). Conclusions: Pre-operative PTBD reduces the number of complications after reconstructive surgeries from 27.3% to 18.2%, and the mortality rate from 18.2% to 9.1% as compared to patients who previously underwent operations without biliary decompression.
( Valeriy Vladimirovich Boyko ),( Yuriy Vladimirovich Avdosyev ),( Anastasiia Lvovna Sochnieva ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: The aim of the study is evaluation of the efficacy of percutaneous transhepatic cholangiography (PTCG) in the diagnosis of the common bile duct diseases complicated by mechanical jaundice. Methods: In the period 2011-2017, 88 patients with the common bile duct diseases were hospitalized: “endoscopically complex forms” of choledocholithiasis - 6 (6,8%), strictures of the common bile duct - 2 (2,3%), strictures of biliodigestive anastomosis - 7 (8%) and cholangiocarcinomas - 73 (82.9%) of different localization according to the Bismuth-Corlette classification. PTCG were performed on the angiograph “Integris Allura 12” (“Philips”, The Netherlands). Results: PTCG was performed in 82 (93.1%) patients. Re PTCG made 20 (22.7%) patients. The diameters of segmental and lobular hepatic ducts ranged from 4 to 12 mm and from 6 to 14 mm, respectively (on average 7.8 mm and 9.6 mm, respectively), and the common bile duct - from 8 to 21 mm (average 13.8 mm). Contrasting with only one part of the liver was noted in 11 (13.4%) patients. The nature and level of obstruction set in 80 (97.5%). The proximal biliary block was detected in 59 (71.9%) patients, distal in 23 (28%). Partial passage of contrast agent in the duodenum was observed in 59 (71.9%) patients, complete occlusion - 23 (28%). Partial passage of contrast medium through the stricture zone was detected in 8 (9.75%) patients. Full biliary block detected in 15 (18.3%) patients, partial - in 67 (81.7%). The sensitivity, specificity and accuracy of PTCG for the common bile duct diseases were calculated: for choledocholithiasis - 80%, 98.5%, 86.5%; for strictures of the common bile duct - 66,6%, 95,7%, 84,1%; for strictures of biliodigestive anastomosis - 71,4%, 95,7%, 87,8%; for cholangiocarcinomas - 98.5%, 92.8%, 97.5% respectively. The wrong diagnosis was made in 2 (2.5%) patients. False-positive conclusions made in 8 (9.8%) and false-negative in 5 (6.1%). Conclusions: PTCG in diseases of the common bile duct complicated by mechanical jaundice in 97.5% of cases makes it possible to contrast all parts of the bile ducts, as well as to assess the level and completeness of the biliary block.