Management for biliary complications in post-operation of hilar cholangiocarcinoma

Abstract

Objective To explore the reasons and preventive measures for biliary complications in post-operation of the hilar cholangiocarcinoma (HCC).Methods From September 1998 to September 2013,we have performed operations for 130 cases of hilar bile duct carcinoma,who were classified into Ⅰ type 11 cases,Ⅱ type 33 cases,Ⅲ type a 36 cases,Ⅲ type b 42 cases,Ⅳ type 8 cases by Bismuth classification.Surgical procedure types included the basic operation type difined as excision with gallbladder,hilar and common bile duct,hepatoduodenal ligament “skeletonized”,and hilar bile duct-jejunum Roux-en-y anastomosis,with or without liver resection.Results The total incidence of biliary complications was 26.2％ (34/130),21 cases of biliary leakage,after drainage of the 19 cases healed in 2 weeks,4 weeks after healing in 2 cases; 7 cases of biliary tract infection,use of antibiotics and cholagogue recovered drug; Stenosis in 3 patients,including 2 cases of reoperation cured,1 case of intrahepatic bile duct after puncture drainage with tube discharge; Gallstone liver abscess (3 cases),after intervention drainage of the whole.This group of 2 cases of death from liver failure,MODS,1 case death.The mortality was 2.3％ (3/130).Conclusions Biliary leakage ranked first in the incidence among biliary complications in post-operation of HCC,and drainage is the best solution for the treatment of biliary leakage. Key words: Bile duct cancer; Surgical procedures; Complications; Bile leakage