[Management of cholangitis complicated in biliary carcinoma with hilar bile duct stenosis].
We reviewed 60 cases of biliary carcinoma with hilar bile duct stenosis which had received percutaneous transhepatic cholangio-drainage (PTCD). Of the 60 cases, nine were complicated with acute cholangitis (AC) and three with segmental acute obstructive suppurative cholangitis (S-AOSC). The incidence of cholangitis was 20%. Six patients with AC and three with S-AOSC underwent hepatic resection for carcinoma. As to preoperative management for cholangitis in these 9 cases, conservative chemotherapy was effective in only 2 cases, and additional PTCD or segmental introduction of the drainage catheter under PTCS were useful in 5 cases. The remaining 2 cases with S-AOSC needed urgent hepatic resection including suppurative hepatic segments after various interventional treatments. No significant difference was found in resectability, morbidity and mortality between the cholangitis group and non-cholangitis group. In conclusion, it is emphasized that postoperative outcome of biliary carcinoma with cholangitis will be improved by adequate PTCD and/or urgent hepatic resection.
Iyomasa
S
S
First Department of Surgery, Nagoya University School of Medicine, Japan.
Nimura
Y
Y
Kamiya
J
J
Maeda
S
S
Kondo
S
S
Yasui
A
A
Shionoya
S
S
D000208:Acute Disease; D000328:Adult; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000601:surgery; D002761:Cholangitis / Q000209:etiology* / Q000628:therapy; D002779:Cholestasis / Q000150:complications*; D003131:Combined Modality Therapy; D004322:Drainage; D004630:Emergencies; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications* / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D008297:Male; D013492:Suppuration