What is the best treatment for bile duct cancer

What is the best treatment for bile duct cancer? Many patients are at a loss when they find themselves suffering from bile duct cancer, because this disease is not a common disease in life, and many people have not even heard of it. However, we cannot ignore the harm of bile duct cancer, so timely treatment is needed. So what is the best treatment for bile duct cancer?

Treatment of bile duct cancer

1. Surgical treatment of bile duct cancer

(1) Choice of surgical method for resectable hilar cholangiocarcinoma:

① Resection of the hilar bile duct, common bile duct and cholecystectomy, and choledochojejunostomy. Applicable to common hepatic duct cancer that has not invaded the liver parenchyma.

② Resection of the quadratic lobe of the liver or part of the right anterior lobe, resection of the hilar bile duct and extrahepatic bile duct, and choledochojejunostomy. Applicable to common hepatic duct cancer or confluent bile duct cancer.

③ Resection of the quadratic lobe or left hemihepatectomy and resection of the hilar bile duct and extrahepatic bile duct, and cholechojejunostomy. Applicable to left hepatic duct and common hepatic duct cancer.

④ Resection of the quadratic lobe or right hemihepatectomy and resection of the hilar bile duct and extrahepatic bile duct, and cholechojejunostomy. Applicable to right hepatic duct and common hepatic duct cancer.

⑤ Super hemihepatectomy or trihepatectomy and resection of the hilar bile duct, extrahepatic bile duct, and part of the caudate lobe, and choledochojejunostomy. Applicable to left or right hepatic duct cancer invading the secondary or higher hepatic duct and the caudate lobe hepatic duct.

⑥ Palliative resection: resection of the quadrate lobe of the liver and the hilar bile duct, extrahepatic bile duct, and choledochojejunostomy, with some residual cancerous tissue such as the caudate lobe hepatic duct or the anterior wall of the portal vein.

⑦ If the main trunk, confluence or anterior wall of the left and right trunks of the portal vein are invaded, the affected part of the venous wall is removed and the blood vessels are repaired and reconstructed, supplemented with intracavitary radiotherapy after surgery.

( 2) Palliative surgery for hilar cholangiocarcinoma: Internal bile-enteric drainage is the preferred palliative surgical method. The principle is that the bile-enteric anastomosis should be as far away from the lesion as possible. The site of the bile-enteric anastomosis is selected according to the dilated bile duct shown by PTC. In some cases, due to the invasion of the hilum of the liver by the lesion or the presence of liver atrophy-hypertrophy complex, the value of anastomosis and drainage of the atrophic lobe bile duct is not great. The hypertrophic lobe bile duct is difficult to expose, so many cases that cannot be resected can only be drained by catheterization. The commonly used method is to dilate the cancerous stenosis and place a T-tube, U-tube or internal support catheter that is as thick and hard as possible. The T-tube can be led out through the common bile duct or through the liver. To prevent slippage, the drainage tube should be sutured and fixed to the bile duct wall and surrounding tissues, and an upper jejunostomy should be made for postoperative bile infusion and tube feeding when necessary. The commonly used method of non-surgical catheterization and drainage is PTCD, and the internal support tube can also be placed after the PTCD sinus is expanded. Pass through the stenosis.

(3) Resection of middle and lower bile duct cancer: Middle and lower bile duct cancer is less common than hilar and papillary cancer. Currently, most scholars recommend resection of the head of the pancreas and duodenum for its surgical treatment. If the middle and lower bile duct cancer cannot be removed, the above palliative methods can be used.

2. Chemotherapy: During the operation, a drug pump catheter is placed through the gastroepiploic artery into the hepatic artery and the pump is buried subcutaneously. After the operation, drugs are administered through the drug pump. The commonly used chemotherapy drug is 5-Fu.MMC.

3. Radiotherapy: intraoperative radiotherapy, postoperative localized radiotherapy and staged internal irradiation, etc. Radical dose radiotherapy has a certain effect on advanced bile duct cancer, because it can cause cancer cell degeneration, necrosis and inhibit its growth, which can prolong the survival of patients with advanced bile duct cancer.