Colangiocarcinom perihilar. Diagnosticul și tratamentul chirurgical

Abstract

Introducere: Pe parcursul anilor 2000 – 2019 in clinica de chirurgie au fost internați 96 de pacienti cu colangiocarcinom de tip Klatskin. Conform clasificarii Bismuth- Corlette tipul I şi II au fost in 15 cazuri, 12 cazuri IIIA, de tip IIIB 11 cazuri. In restul 58 de cazuri au fost tumori Klatskin tip IV. Procesul de diagnostic a inclus examenul clinic a pacientului, testele de laborator, USG (Ultrasonografie) abdominala, CPGRE (colagiopancreatografie retrograda endocopica), RMN (Rezonanta magnetica nucleara) regim colangiografic. Aceste investigaţii sunt metode de diagnostic de electie pentru determinarea tumorilor Klatskin. Material si metode: Tratament chirurgical efectuat la 42 (43,7%) de pacienti. Rezectia CBP (calea biliara principala) cu aplicarea bihepaticojejunoanastamozei efectuata in 15 cazuri, hepatectomie reglata stanga la 11 bolnavi si hepatectomie reglata dreapta efectuata 12 bolnavi, cu restaurarea continuitatii tractului digestiv prin aplicarea hepaticojejunoanastamozei in Y a la Roux. Toate tipurile de operatii sau asociat cu rezectia segmentului I. Concluzii: Algoritmul de diagnostic la bolnavi cu tumori tip Klatskin include examenarea clinica a pacientului, testele de laborator, USG abdominala, CPGRE, RMN regim colangiografic. Tratamentul chirurgical a bolnavilor cu tumori tip Klatskin consta in rezectia CBP, hemihepatectomie pe dreapta sau stinga. Toate operatiile trebuie sa fie extinse la rezectia lobului caudat.

Introduction: 96 patients with Klatskin tumor were admitted to surgical department during the period of 2000-2019 years. According to the Bismuth-Corlette classification 15 patients were with type I and II of tumor, 12- with type IIIA, 11 - with type IIIB. The last 58 cases were represented by patients with Klatskin tumor type IV. Diagnostic was confirmed by clinical examination, laboratory tests, ultrasound, ERCP, MRI with cholangiography. These procedures are the methods of choice in the diagnostic of perihilar cholangiocarcinoma. Materials and methods: Radical surgical treatment was performed in 42 (43,7%) patients. The resection of common bile duct with performing of bihepaticojejunoanastomosis was applied in 15 cases, left hepatectomy - in 11 cases and right hepatectomy - in 12 cases with preserving of digestive tract integrity by loop Y a la Roux. All types of operations were associated with segment I resection. Conclusions: Diagnostic algorithm in patients with Klatskin tumor includes clinical examination, laboratory investigations, abdominal US, ERCP, MRI cholangiography. Radical surgical treatment of patients with Klatskin tumor consists in resection of common bile duct, left or right hemihepatectomy. All types of operations should be associated with resection of caudal lobe.