Bile duct tumors

　　Gallbladder cancer often develops from recurrent acute inflammation, which promotes atrophy of the mucosa of the bile duct or gallbladder, resulting in infiltration of lymphocytes and monocytes in all layers of the tissue, and obvious fibrosis. Due to long-term chronic inflammation stimulation, some gallbladder duct walls or cyst walls may become thickened due to edema and fibrous tissue proliferation, causing local stenosis of the tubes, sometimes reaching the muscular layer, forming Rokitansky-Aschoff sinuses. This phenomenon can be seen in about 90% of cases of chronic cholecystitis, and canceration can occur on this basis, becoming gallbladder cancer.

　　1. The majority of cases show gradual weight loss, weight loss, fatigue, and present with an evil disease constitution.

　　2. In some cases, the lymph nodes above the clavicle can be palpable due to metastasis, and metastatic tumors may also appear in the breast and other places.

　　3. In advanced cases, gastrointestinal bleeding, ascites, and signs of liver function failure may occur due to compression of the portal vein.

　　4. Obstruction of the common bile duct by abscess can cause multiple liver abscesses, and the formation of abscesses in the gallbladder cavity or around it where the tumor occurs is common

　　Jaundice is progressive or intermittent; pain and the nature of pain are related to diet; symptoms such as fever, chills, nausea, vomiting, aversion to oil, decreased appetite, weight loss, diarrhea, grayish change in feces, changes in urine color, and skin itching. Physical examination shows jaundice of the sclera and skin, lymph nodes above the sternum are enlarged; abdominal tenderness; liver tenderness; gallbladder enlargement and tenderness; spleen enlargement, signs of ascites and abdominal mass, and necessary digital rectal examination.

　　Maintain a pleasant psychological state, develop good dietary habits for tumors, avoid spicy foods, eat less greasy foods, and do not drink strong alcohol. Early diagnosis of this disease is crucial and should be carried out regularly

　　1. Ultrasound examination

　　It is a commonly used imaging diagnostic technique for diagnosing biliary tract tumors. The biliary tract cancer at the hilum of the liver shows dilated intrahepatic bile ducts, an empty gallbladder, and non-dilated extrahepatic bile ducts; the bile duct cancer at the lower end shows obvious dilatation of both intrahepatic and extrahepatic bile ducts, accompanied by gallbladder enlargement; the bile duct cancer at the middle segment shows dilatation of intrahepatic and hilum bile ducts; pancreatic head cancer shows enlargement of the pancreatic head and实质性 space-occupying lesions.

　　2. X-ray examination

　　Intravenous cholangiography is not suitable for use in obstructive jaundice or significant liver function impairment, and it is necessary to perform barium meal examination of the gastrointestinal tract; it has certain value for the diagnosis of pancreatic head cancer and duodenal papillary cancer.

　　3. CT examination

　　CT is of the same diagnostic value in understanding the location of biliary obstruction as the above ultrasound examination; CT is clearer than ultrasound in showing gallbladder lesions or gallbladder tumors, hepatic parenchymal space-occupying lesions, whether the hilum and retroperitoneal lymph nodes are involved, and whether there are head and tail lesions of the pancreas. Magnetic resonance cholangiopancreatography (MRCP) is very helpful in diagnosing biliary obstruction, and the above-mentioned examinations

　　1. Ultrasound examination

　　It is a commonly used imaging diagnostic technique for diagnosing biliary tract tumors. The biliary tract cancer at the hilum of the liver shows dilated intrahepatic bile ducts, an empty gallbladder, and non-dilated extrahepatic bile ducts; the bile duct cancer at the lower end shows obvious dilatation of both intrahepatic and extrahepatic bile ducts, accompanied by gallbladder enlargement; the bile duct cancer at the middle segment shows dilatation of intrahepatic and hilum bile ducts; pancreatic head cancer shows enlargement of the pancreatic head and实质性 space-occupying lesions.

　　2. X-ray examination

　　Intravenous cholangiography is not suitable for use in obstructive jaundice or significant liver function impairment, and it is necessary to perform barium meal examination of the gastrointestinal tract; it has certain value for the diagnosis of pancreatic head cancer and duodenal papillary cancer.

　　3. CT examination

　　CT is of the same diagnostic value in understanding the location of biliary obstruction as the above ultrasound examination; CT is clearer than ultrasound in showing gallbladder lesions or gallbladder tumors, hepatic parenchymal space-occupying lesions, whether the hilum and retroperitoneal lymph nodes are involved, and whether there are head and tail lesions of the pancreas. Magnetic resonance cholangiopancreatography (MRCP) is very helpful in diagnosing biliary obstruction.

　　4. Endoscopic retrograde cholangiopancreatography

　　(ERCP) For patients with obstructive jaundice, understanding the location and cause of the obstruction before surgery can provide important diagnostic evidence. For patients with incomplete biliary obstruction, it can clearly show the intrahepatic and extrahepatic bile ducts, indicating that the lesion is located at the hilum of the liver, the middle segment of the bile duct, or the lower end of the bile duct, and clearly show the degree and extent of the lesion, providing important evidence for surgical treatment. In patients with complete biliary obstruction, ERCP can only show the truncation sign at the site of obstruction, and cannot show the proximal bile ducts near the obstruction or the extent of the obstruction; To understand the condition of the proximal bile ducts, PTC examination is dependent. There is a risk of acute suppurative cholangitis with ERCP examination, and it should be very cautious in patients with obstructive jaundice.

　　5. PTC examination

　　Important examinations for further diagnosis of biliary tract tumors to clarify the location of the tumor. PTC can cause multiple complications such as bleeding, infection, and bile leakage, and indications should be strictly controlled, and it is usually performed before surgery.

　　Reduce the intake of fats, especially animal fats, and pay attention to the diet for bile duct cancer. Avoid eating fatty meat and fried foods as much as possible and replace animal oil with vegetable oil. Cooking food is best done by steaming, boiling, stewing, and braising. Pay attention to not eating a large amount of fried, fried, roasted, smoked, and preserved foods. Increase the intake of fish, lean meat, dairy products, fresh vegetables, and fruits that are rich in high-quality protein and carbohydrates to ensure calorie supply, thereby promoting the formation of glycogen, and protecting the liver.

　　1. Simple cholecystectomy is suitable for patients with stage Nevin I. For patients who have had cholecystectomy due to gallstones or other reasons and unexpectedly found gallbladder cancer in pathological examination, if the lesion is limited to the gallbladder mucosa, no further surgery is necessary.

　　2. Radical cholecystectomy for gallbladder cancer is suitable for patients with stages Nevinn, III, and IV. The resection range includes not only the gallbladder but also a liver wedge resection 2 cm away from the gallbladder bed and lymph node dissection of the gallbladder drainage area. On the basis of radical surgery, extended radical surgery can be performed, including right hemihepatectomy or right trilobectomy, pancreaticoduodenectomy, portal vein reconstruction, etc., which has a large surgical trauma and is not significantly effective.

　　3. Palliative surgery is suitable for patients with advanced stages who have obstructive jaundice and cannot undergo surgical resection to relieve symptoms. If the common bile duct is not invaded, a Roux-en-Y anastomosis of the common bile duct with the jejunum can be performed. For patients with complete obstruction of extrahepatic bile ducts, a left hepatic duct jejunal anastomosis, or PTCD, or endoscopic sphincterotomy, can be performed to place a stent in the opposite direction at the site of obstruction of the common bile duct or common hepatic duct to relieve obstructive jaundice. For patients with duodenal obstruction, a gastrojejunal anastomosis can be performed.