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KMID : 0365719920080010098
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Journal of Pusan Surgical Society
1992 Volume.8 No. 1 p.98 ~ p.106
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A Clinical Consideration of Extrahepatic Bile Duct Cancer
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Abstract
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The extrahepatic duct cancer is an uncommon malignant tumor leading to progressive biliary obstruction, sepsis, secondary biliary cirrhorsis, and hepatic failure. Prognosis is generally poor. metastasis tend to develop late in the course of the
disease.
However resectability rates and long term survival rates remain low because of the difficulty of early diagnosis and the proximity of these tumors to vital structures. The neoplasm tends to grow slowly and to infiltrate surrounding structures
such
as
liver parenchyma, intrahepatic bile ducts and hepatic pedicle. Then at early diagnosis, currative resection is possible because of character of cancer, but at diagnosis, surgical resection is impossible in most of cancer, In most series, the most
treatment method many be the palliative surgical bile duct drainage.
Thirteen cases of primary adenocarcinoma of extrahepatic bile ducts(gallbadder and periampullary tumors excluded) surgically treated at pusan medical center during 2 years from January 1990 through September 1992 were studies retropectively
@ES The results were as follows :
@EN 1. The sex ratio of male to female 1.6 : 1, the mean age was 65 years with a range of 50 to 70 years of only older age.
2. Clinical manifestation were jaundice(84.6%), anorexia(76.9%), RUQ pain(61.5%), indigestion(53.8%), epigatric discomfort(53.8%), weight loss(53.8%), RUQ tenderness(84.6%).
3. The Liver function test finding were elevated serum bilirubin(84.6%), SGOT(76.9%), SGPT(84.6%), serum alkaline phosphatase(69.2%) than normal level.
4. The most useful diagnostic study were ERCP(90%), PTC(75%) CT(75%) before surgery.
5. The associated disease were liver cirrhosis(30.8%), clonorchis sinensis(30,.8%), gall stone(7.7%) in order.
6. Gross & histologic finding were the proximal portion(46.2%), middle(38.4%) & well differentiated type(45.5%), poorly differentiated type(45.5%) of 11 cases confirmed pathologically adenocarcinoma.
7. The operative procedure was palliatively internal drainage in 6 cases & external drainage in 7 cases.
The postoperative complication was wound infection 4, bile leakage 3, etc, in order.
The operative mortality was 16.6% in 2 cases, due to bile leakage & sepsis. The mean survival period in 11 cases, in 6 cases of internal drainage, in 5 cases of external drainage was 10 months, 12.8 months, 8.4 months respectively. The mean
survival
period in 5 cases of well differentiated type, in 5 cases of poorly differentiated type was 15 months & 6.9 months respectively. The results show that internal drainage group & well differentiated type group had a better prognosis than external
drainage
group & poorly differentiated type group.
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