Cancer _ general knowledge of bile duct outside the liver

Cancer _ general knowledge of bile duct outside the liver
[Sum up ]
It is generally bile duct cancer outside liver that the liver is in charge of cancer. Because clinical manifestation and therapeutic method of gallbladder underpart cancer or pot belly cancer of person in over-all charge are basically the same as pancreas head cancer, often classify as cancer around the belly of pot.
[Diagnose ]
Self-application " B " Type check supersonic wave and by livers leather last cholangiography skill, already might make by the diagnosis of bile duct cancer by skill. But " B " Type supersonic wave check generally can only distinguish jaundice is obstruct or obstruct to cause in liver outside liver, can't clearly illustrate pathological change properties. So while finding that it is and not calculus to obstruct outside the liver, should check in order to diagnose clearly PTC. PTC is a main method to diagnose bile duct cancer, the making a definite diagnosis of rate can reach 94- 100%. If PTC radiography can also fail by the gallbladder pancreatic duct radiography skill of driving in the wrong direction of the endoscope, can confirm position and range of cancerous swelling, but under already causing the complete obstructive situation, can't understand the range soaked in near side of cancerous swelling in radiography, it is its weak point. The diagnosis only satisfied with bile duct cancer still dislikes insufficiently, should understand the range of cancerous swelling and soak the intensity that is near organizing, in order to judge tentatively before the skill whether cancerous swelling could excised or made other operation schemes. The intersection of angiography and skill, include the intersection of alternative and the intersection of liver and the intersection of artery and radiography, the intersection of spleen and the intersection of portal vein and radiography and puncture the intersection of portal vein and the intersection of radiography and skill,etc. by leather liver can with better to judge whether bile duct cancer will you please be excised. But can't find out about the situation of the lymphocytic transformation, and whether the liver end leaf has been invaded. The X-ray fault of the electronic computer scans (CT) Can help to judge whether cancerous swelling has already infringed the liver essence. Checking as described above still can't diagnose clearly, can only rely on the operation to ascertain finally. But will become difficult sometimes. Often present moving under water growth in the gallbladder tube wall because of cancerous swelling at first, so it is more difficult to fetch to the appropriate sample. The mirror is examined and often presented a pile of cancer cells to organize the parcel by the dense fiber in the section. Difficult and primary hardening cholangitis distinguishes, often need numerous pathologic cut sections for microscopic examination to make a definite diagnosis of sometimes.
[Treat the measure ]
Because bile duct cancer is grown slowly and concealed, most patients' tumour takes place and in charge of converging the place in the liver, cancerous swelling has often already soaked the surrounding tissue at the time of the operation, so the excising rate of operation is very low, about fewer than 20%. Only 2 can excise in one group of hospitals and 50 Zhongshan. If the liver is in charge of converging cancerous swelling in the place and can be excised, need to make the bile duct in liver of both sides and fit with jejunum. Someone still maintains that makes and expands the right lobe of the liver to excise. After the intersection of bile duct and cancer, 1/3 of China, excise, can make bile duct jejunum identical, remove lymphocytic adipose tissue of liver in the duodenum ligament at the same time. Can do the pancreas duodenum and excise the skill in making 1/3 sections of bile duct cancers. The intersection of bile duct and the intersection of cancer and person who can't excise, palliative treatment to relieve jaundice mainly, such as in obstructing the proximal expansion bile duct, it is in charge of putting T, the Model Y tube or U type is in charge of guiding outside; If there are conditions, the bile duct or gallbladder that can be expanded fits with jejunum. Have already more employed and guided the method outside by what the leather liver is punctured in recent years, has put the drainage tube into obstructing the proximal inner bile duct of liver is PTCD; Or miss the conduit in the narrow place of tumour, put and enter to support the tube namely PABD, enable bile to flow into the duodenum. The above-mentioned method not merely can lighten the patient's symptom, can also improve liver function, and create certain condition for radiotherapy and chemotherapy in the future, can lengthen the patient's life to a certain extent. Terblanche reports 15 bile duct cancer patients making the radiotherapy after other drainage, 10 examples survive for over 1 year, 2 survive for over 2 years. The prognosis of bile duct cancer is relatively bad, average life cycle when the operation excises the group is 13 months, persons who have seldom survived for 5 years. The group survives for 6- 7 months on average to put the tube and reduce pressure, over 1 year for few people.
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