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Abstract: The patient had been suffering from right upper abdominal distension and discomfort for 6 months. He visited the clinic for worsening symptoms in the past 1 month, and an outpatient abdominal ultrasound examination suggested a huge occupancy in the liver with a diameter of about 13 cm, which was initially assessed as a liver tumor. The patient was recommended to be admitted for surgical treatment. Through preoperative precise assessment, the patient’s tumor could be resected, and the patient was given hepatectomy under general anesthesia. After the operation, the discomfort in the right upper abdomen disappeared and the tumor was radically resected.
Basic information】Male, 72 years old
Disease Type】Intrahepatic cholangiocarcinoma
Hospital】Liaocheng People’s Hospital
Date of Consultation】November 2021
Treatment plan] Hepatectomy + medication (cefoperazone sodium for injection, diammonium glycyrrhizate capsule, ursodeoxycholic acid capsule, fatty lactic acid (18) injection)
[Treatment period] Hospitalization for 2 weeks, review after 1 month
Treatment effect] Disappearance of right upper abdominal discomfort and radical resection of tumor
I. Initial consultation
Today, a wasted elderly patient came to the outpatient clinic, because the patient was thin and yellowish, the first feeling was that the patient was in a state of chronic consumption of malignant tumor. After asking the patient about his medical history, the patient complained of right upper abdominal distension and pain for about 6 months, but the symptoms had worsened in the past month, so he came to the clinic. In the outpatient clinic, the patient was routinely given an abdominal ultrasound examination, which suggested a huge tumor in the right lobe of the liver, about 13 cm in diameter, and was considered to be a bile duct cell type liver tumor. Tumor markers were checked and CA19-9 was significantly increased. For further treatment, the patient was admitted to the hospital.
II. Treatment process
Because the patient’s tumor was relatively large in size at present, the patient had to be evaluated precisely in terms of treatment. An intensive CT examination of the abdomen was performed, suggesting a huge right hepatic mass of about 13 cm in diameter with several relatively small satellite foci around the tumor. Intensive CT assessment of the tumor is resectable and can achieve a relatively good resection effect, which can be combined with comprehensive treatment after surgery. At present, surgery is preferred for intrahepatic cholangiocarcinoma. Therefore, after explaining the condition and treatment plan to the patient’s family, the family agreed to perform surgical treatment. After active preoperative preparation, elective hepatectomy was performed under general anesthesia. Postoperative pathology confirmed that it was intrahepatic cholangiocarcinoma with negative tumor margins and no tumor residue was seen in the bile duct section of the liver. Postoperatively, the patient was given cefoperazone sodium for injection to fight against infection, diammonium glycyrrhizate capsule to protect liver, ursodeoxycholic acid capsule to benefit bile, and fatty milk amino acid (18) injection for nutritional support.
III. Treatment effect
Because of the large size of the tumor, because of the precise surgical planning done before surgery and the resection route planned before surgery, the surgical result was better. At the same time, the patient was given active postoperative rehabilitation, and there were no complications such as liver failure and abdominal infection. The patient gradually got out of bed on the 3rd postoperative day, and started to eat gradually on the 4th postoperative day. On the 7th postoperative day, he could basically resume normal activities, and the symptoms of right upper abdominal discomfort disappeared, and he was discharged after 2 weeks of hospitalization.
IV. Notes
We are glad that the patient was discharged from the hospital after treatment. However, because the patient had an open surgery, the trauma was relatively large, and the removal of stitches had to wait until about half a month after the surgery. After discharge, patients should pay attention to more rest, avoid strenuous activities, pay attention to increase nutrition, you can eat more lean meat, eggs, milk, fish and shrimp and other high-protein substances to promote the healing of the incision, but also eat more fresh fruits and vegetables to supplement the necessary vitamins. The review items mainly include blood routine, liver function, tumor markers, and abdominal CT to observe whether there is abdominal infection, liver insufficiency or tumor recurrence. If there is no special condition in the above examinations, the patient should be admitted again for comprehensive anti-tumor treatment after the physical condition has returned to normal.
V. Personal insight
Intrahepatic cholangiocarcinoma is a common type of liver malignant tumor, which is a malignant tumor derived from bile duct cells. It is more malignant than hepatocellular liver cancer and has a worse prognosis. Surgery is the preferred treatment, and chemotherapy can be administered after surgery. Intrahepatic cholangiocarcinoma often causes symptoms such as discomfort and weakness in the right upper abdomen. Therefore, if such symptoms occur, one should be alert to liver lesions and seek medical examination in time to avoid delaying treatment.