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Abstract: The patient in this case came to the hospital due to facial yellowing and yellowing of urine. Through liver function, routine ultrasound and intensive CT, the patient was confirmed to have bile duct tumor, and the pathological results showed: bile duct malignant tumor. Later, after communicating with the patient and his family, surgery + chemotherapy was recommended as treatment. The surgical treatment mainly consisted of common bile duct resection and simultaneous bile-intestinal anastomosis. After a period of active and effective treatment, the symptoms gradually disappeared and the postoperative recovery was good.
Basic information】Male, 72 years old
Disease Type】Malignant tumor of bile duct
Hospital】Liaocheng People’s Hospital
Date of consultation】November 2021
Treatment plan】Surgical treatment (common bile duct resection + bile-intestinal anastomosis) + chemotherapy
Treatment Period】14 days in hospital
Effectiveness】Tumor local excision, little trauma, good postoperative recovery
I. Initial Consultation
One day in November 2021, an elderly male patient came to the clinic. From the appearance, we observed that the patient had a yellowish complexion and reported that his urine was also yellow, and he had lost weight recently. The liver function indicated that the transaminase bilirubin was significantly elevated, indicating the presence of obstructive jaundice; the ultrasound examination showed that there was an occupancy in the middle part of the common bile duct.
II. Treatment process
After admission, we considered whether to perform a local resection of the common bile duct without an extended surgery to reduce the trauma and pain of the patient. However, this assessment required an intensive CT examination, which showed that there was a malignant tumor of about 1 cm × 2 cm in the middle part of the common bile duct, which was at a certain distance from both the upper and the end of the common bile duct, with the possibility of local resection. However, if there was a tumor in the upper section of the common bile duct, partial hepatectomy might be required; if there was a tumor in the lower section of the common bile duct, pancreaticoduodenectomy might have to be performed, which was a big change in surgery. Fortunately, there was no tumor residue in the upper and lower margins of the bile duct. This also indicates that the tumor was excised cleanly during the operation, and then a biliary-intestinal anastomosis was performed for the patient. Since the surgery was relatively less invasive, the patient recovered relatively well after the surgery.
III. Treatment effect
Because of the intraoperative pathological confirmation, the surgical resection was relatively complete and could be said to be a radical resection, and the scope of surgical resection was relatively small, so the surgical trauma to the patient was less. The surgery solved the biliary obstruction, so the postoperative bilirubin plummeted, the symptoms of yellowing skin gradually improved, and gradually the diet began to resume. The patient was able to start a liquid diet 3 days after surgery, and was already able to transition to normal eating 7 days after surgery, and was discharged cured at 14 days of hospitalization. In addition to the above-mentioned necessary surgical treatment, the patient was advised to undergo routine chemotherapy after surgery to consolidate the therapeutic effect of surgery. The patient was also very satisfied with the results of this treatment.
IV. Notes
The patient in this case had a successful surgery and gradually improved, so we are truly happy for him. When discharged home after surgery, first of all, attention should be paid to diet, because after surgery, the patient’s gastrointestinal tract has been rerouted, therefore, the principle of small and frequent meals and balanced nutrition should be followed, and it is recommended to eat easily digestible, easily absorbed and nutritious food; avoid overeating, spicy and stimulating food and oily food. In addition, patients should review regularly. Generally, after radical surgery for malignant tumor, it should be reviewed once in about 2 months, and it can be changed to once in about 3 months after half a year. The purpose of review is to detect the recurrence of tumor at an early stage, so as to get better treatment effect through early treatment.
V. Personal insight
Bile duct tumors are becoming more and more common with higher incidence. Bile duct tumors often require pancreaticoduodenectomy or partial hepatectomy, which are very traumatic and cause a lot of pain to the patient, and the complications of the surgery are also very many. There are relatively few cases where local resection of choledochal tumor can be done. As in the present case, timely detection and early diagnosis of the disease can lead to more prominent treatment effect.