Objective　To evaluate the methods for the diagnosis and treatment of biliary malignant tumor(BMT) so as to achieve improvement. Methods　Various methods of diagnosis and treatment of BMT were comprehensively analysed and evaluated. Results and Conclusion　The present laboratory examinations do not show obvious help for the early diagnosis of BMT. Both bile cytology and neoplasm histology may define the character of tumor but the positive rate is low. Although imaging examinations have difficulty in finding early tumor, it may help to define the position, size, infiltration and metastasis of the neoplasm. To diagnose the tumor in its early stage, the monitor and management of some diseases related to BMT should be enhanced, and tumor markers with high susceptibility and specificity should be explored. Operation is the major choice treatment. For advanced neoplasm patients, radical operation or extented radical operation can bring great help for some cases. Palliative surgery may be performed on the patients unable to accept radical operation, and biliary drainage may be performed on the unresectable tumor. The application of special surgery apparatus, such as Peng's Multifunctional Operative Dissector(PMOD), may increase the resection rate of tumor and lymph nodules. Radiotherapy and chemotherapy need further exploration. Gene therapy may likely bring about new hope for the treatment of BMT in the future.

Objective To investigate the cause,prevention and treatment of bile leakage. MethodsThe clinical data of 22 cases with bile leakage treated from Jan.1993 to Dec.1998 were reviewed retrospectively. Results Of the 19 cases treated with nonoperative therapy,1 patient died,3 patients were transferred to be operated later, and the other 15 cases were cured. The cure rate of nonoperation was 79%(15/19). 3 patients were cured with emergent operation at the beginning of bile leakage. Of the 3 cases who were transferred to be operated later,2 cases were finally cured by operation while the other 1 patient was not cured.The total cure rate was 91%(20/22). ConclusionBile leakage often oocurs in cholecystectomy procedure and after removal of a T tube, which is mainly related to inflammation, adhesion, abnormality of anatomy and incorrect manipulation. In order to prevent it,surgeons should pay more attention to the 3 links of prirnary procedure, including preoperative preparation,operative management and postoperative treatment. Different treatments are optional according to the degree of leakage and the condition of patients.

Radical resection is still the only possible cure for gallbladder cancer nowadays. Rational procedures vary according to different TNM stages, locations and biological behavior of tumor. Diagnostic laparoscopic exploration offers the opportunity to identify peritoneal metastasis which may be negative on preoperative radiological findings. Besides, this can also minimize trauma to abdomen. Therefore, laparoscopic exploration is suggested in cases highly suspected of peritoneal metastasis. For incidental gallbladder cancer, radical surgery should be performed because of positive margin of cystic duct, inadequate trocar management or advanced tumor stages. Timing for reoperation is still controversial. Most scholars recommended that it should be proceed within two months after the first surgery.

Hilar cholangiocarcinoma remains a formi-dable challenge to hepatopancreatobiliary surgeons since the reported resection of a primary cancer originating at the hepatic duct confluence by Brown and Myers in 1954. Emerging evidence has indicated that aggressive surgery with a curative resection offers a better option for long-term survival compared with conservative therapy. Liver transplantation has also been considered as a management opportunity for the treatment of cholangiocarcinoma. However, the survival rate has been poor due to the high proportion of disease recurrence. This review highlights recent techniques in hilar cholangiocarcinoma resec-tion, with special attention to the management of the resection margin, clinical skills of liver resection, lymph node clearance, and portal vein or hepatic artery resection or reconstruction. In addition, technical advances have been proposed in hepatopan-creatoduodenectomy and liver transplantation for hilar cholangio-carcinoma treatment. In the current hepatic procedures, promis-ing survival outcomes have been obtained in patients with hilar cholangiocarcinoma, exhibiting a decreased operative mortality and a steady improvement in long-term survival. Overall, the correct clinical strategy and appropriate surgical techniques may provide an increased chance to cure patients with hilar cholan-giocarcinoma.

Iatrogenic bile duct injuries (BDIs) and subsequent benign biliary stricture is a medical catastrophe which is associated with significant perioperative morbidity and mortality,reduced long-term survival rate and poor quality of life.For most major BDIs (Strasberg classification E1-E4),the recommended method of repair is hepaticojejunostomy (HJ).We conducted a retrospective review aiming to examine the surgical technique of high HJ at our institution.This review highlights 4 aspects in the operation which include the hepatoduodenal ligament exposure,hepatic artery and its branches protection,exposing the intrahepatic bile duct above the stricture plane,and HJ techniques.Overall,the optimal long-term result of surgical management depends on the availability of experienced hepatobiliary surgeons and a considerable large HJ anastomosis above the stricture.

Objective To investigate the extent and the relevant factors for local lymph node metastasis of gallbladder carcinoma. Methods Clinicopathologic features of 34 patients with gallbladder carcinoma who underwent radical resection were analyzed retrospectively. Results The overall lymph node metastasis rate was 68%(23/34), with 0(0/3) in T 1 stage, 43%(3/7) in T 2, 85%(11/13) in T 3, and 82%(9/11) in T 4. The metastasis rate was 29%(10/34) in gallbladder lymph nodes, 44%(15/34) in pericholedochal, 18%(6/34) in hepatic hilum, 24%(8/34) alongside proper hepatic artery, 21%(7/34) in periportal vein, 38%(13/34) in retropancreaticoduodenal, and 4/6 in paraaortic region. Conclusions Lymph node metastasis was determined by the depth of invasion of the primary tumor. The extent of surgical dissection was made according to the exploration and result of intraoperative biopsy.

ObjectiveTo summarize the experience in diagnosis and treatment of malignant change in choledochal cyst patients in the past 20 years. MethodsThe clinical data of 16 patients admitted from 1980 to 2000 were analyzed retrospectively. Results9 patients had had a previous internal drainage procedure,12 patients had biliary tract infection, 4 cases presented with abdominal masses. All suffered body weight loss and general malaise. ERCP was performed in 5 cases with no previous operation, in which abnormal pancreatobiliary duct junction was found in 4 patients. Laparotomy plus metastatic lymph node biopsy was performed in 4 patients, choledochotomy with T-tube drainage for 4 patients, cyst excision and pancreatoduodenectomy for 3 cases, partial cyst excision with left lobectomy for 2 patients, cyst excision with Roux-en-Y hepaticojejunostomy for 3 patients. Pathology proved carcinoma was located in cyst wall in most cases.Postoperative survival time ranged from 4 to 31 months with a mean of 12.7 months. ConclusionsThe clinical symptoms of malignant change in congenital choledochal cyst were non-specific. The preoperative diagnosis for canceration was difficult, and the prognosis was poor.Total extrahepatic choledochocele resection should be adopted for the prevention of canceration.Intraoperative frozen section is helpful to confirm diagnosis. Cyst excision with pancreatoduodenectomy is the treatment of choice for carcinoma invading pancreatic head.

Objective To investigate the value of partial hepatectomy in the treatment of hilar cholangiocarcinama( HCC). Methods In this report, 42 patients with hilar cholangiocacinoma treated surgically were analyzed retrospectively. Results Of the 42 patients, 34 cases (81%) underwent surgical resection. In these 34 cases, 15 cases were treated by local resection, 8 cases by a combination of right lobectomy, 3 cases by left lobectomy, 4 cases by left lobectomy and caudate lobectomy, 1 case by left lateral lobectomy and caudate lobectomy, 3 cases by quadrate lobectomy. Curative resection was performed in 25 patients. The median survival rate in patients with curative resection was 28 months, while that with palliative operation was 14 months. The 1-, 2-, and 4-year survival rates of curative resection were 90% , 73% , and 28% , respectively. The 1-, and 2-year survival rates of palliative operation were 57% , and 27%. Conclusion Survival rates in patients with curative resection were better than that of palliative operation. Radical resection in many cases demands a combined liver resection.

Objective To investigate the effect of surgical treatment for giant primary liver cancer.Methods One hundred and forty-six cases of giant primary liver cancer received surgical treatment in recent 11 years ware analyzed retrospectively. Of them, 99 cases underwent irregular hepatectomy ,28 hemihepatectomy and 4 right hepatic trisegmentectomy .Including 19 cases received secondary resection after preoperative TACE, meanwhile 6 cases were underwent portal venous cancer thrombus extraction, 15 cases received biopsies and DDS only, Interoprative DDS were performed in 105 cases. Result The postoperative complications was 10.3 %, the postoperative mortality was 1.4%.The 1-,3-,5- and 10year survival rates were 56.6 %, 30.2% ,14.4% and 2.1% respectively. Conclusions The main treatment of giant liver cancer is hepatcctomy.Combination with TACE,portal thrombus extraction and DDS can improve the long-term survival.

Objective To explore the feasibility of orthotopic spleen-p re served operation characterized of taking advantage of collateral circulation.Methods 12 cases with severe injuries of the spleen and its pedicle underwent splenic pedicel ligation and irregular subtotal splenectomy.R esults All patients had good operative and postoperative results and no postoperative complications.Ultrasonography and CT scanning showed that the remn ant of spleen had no infarct and secondary hemorrhage.Conclusion Orthotopic spleen-preserved operation using collateral circulation is useful i n treating severe traumatic rupture of spleen accomplied by destruction of sple nic pedicles.