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Abstract: A 45-year-old middle-aged male patient with no obvious cause of jaundice and malaise was diagnosed with hepatoportal cholangiocarcinoma after ultrasound and CT examination, and the patient had missed the opportunity for surgery due to the late stage. After full communication with the patient and family, it was decided to perform palliative drainage first to relieve jaundice, so ERCP stent implantation treatment was performed, and the postoperative drainage effect was fair. After 6 days of hospitalization, the patient’s condition was controlled and stable, and jaundice was relieved.
Basic information】Male, 45 years old
Disease Type】Hilar cholangiocarcinoma
Hospital】The First Hospital of Jilin University
Date of consultation】December 2021
Treatment plan】ERCP stenting
Treatment Period】6 days of hospitalization and monthly outpatient review
Effectiveness】Stable disease control, jaundice relief
I. Initial consultation
One winter morning, we saw a middle-aged male patient, 45 years old, slightly fat, emaciated, with jaundice, and no strength in speech. After careful inquiry, the patient had no previous history of hepatitis, no surgery, no history of trauma or medication, and the ultrasound done in the outpatient clinic showed significant dilatation of intrahepatic bile ducts. On the one hand, the patient was prescribed a hepatobiliary enhancement CT examination, and on the other hand, his family was asked to come to assist in the examination and treatment.
II. Treatment history
After the family arrived at the hospital, they assisted the patient to do the enhanced CT examination actively. 2 days later, the examination results indicated that the intrahepatic bile ducts were obviously dilated, the bile ducts were obstructed in the hilar region, the bile ducts in the whole hilar region were obviously thickened, the left and right hepatic ducts were involved, and the invasion range was relatively wide, so the patient was diagnosed with hilar bile duct cancer, and the stage was relatively late. The patient had missed a good opportunity for surgery, and it was better to have liver transplantation, but liver transplantation required a lot of money and was a huge risk. After communication, the family and the patient expressed that they wanted to have palliative drainage to relieve jaundice and then medication. After detailed examination, the protocol developed was ERCP stenting, and a combined metal plus plastic stent was placed endoscopically for drainage with fair drainage results.
III. Treatment results
The patient developed mild pancreatitis during the postoperative recovery period, which is a common complication after ERCP, mainly because the operation itself and the stent can irritate the pancreas, and after anti-inflammatory treatment the pancreatitis gradually subsided without abdominal pain symptoms. After the anti-inflammatory treatment, the pancreatitis gradually subsided and the abdominal pain was gone. After 6 days of hospitalization, the patient was discharged from the hospital. The patient was instructed to undergo liver function and other related tests every month, and CT examinations were performed in the 1st and 3rd months. In addition, the family and the patient preferred further anti-tumor treatment, and immunotherapy and chemotherapy were recommended at the oncology center.
IV. Precautions
The patient was treated with ERCP stent implantation, and her condition was temporarily stabilized and jaundice was relieved, which was slightly reassuring as the treating physician. However, inwardly, we are still worried about the patient because the overall prognosis of hepatoportal cholangiocarcinoma is relatively poor. There are many considerations after the patient’s discharge from the hospital. Firstly, anti-tumor treatment should be followed after discharge, and it is recommended to carry out targeted anti-tumor treatment in the specialty, mainly including immunotherapy and chemotherapy. Secondly, if there is tumor recurrence and jaundice, liver function and CT examination must be performed, and surgical treatment if necessary. In daily life, good mind, avoid bad emotion; reasonable diet, mainly light and nutritious, eat less and more meals.
V. Personal insight
Anal cholangiocarcinoma is a type of cholangiocarcinoma and surgery is the main treatment, including open surgery and laparoscopic surgery. However, since most patients with hilar cholangiocarcinoma have lost the chance of radical surgery and can only receive palliative treatment, ERCP stenting is a type of surgery with less trauma, faster recovery and lower cost. However, this treatment method also has disadvantages, such as complications and reflux cholangitis, which need the attention of patients and doctors. In addition, the patient in this case also reminds us that we should seek early medical attention and treatment to avoid delaying the best time for treatment, which may adversely affect the patient’s survival and quality of life.