The strategy of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Jianming , CHEN Ziyang ,  GAO Feng

Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, P. R. China;

Corresponding?author：

GAO Feng, Email: gf9777@126.com

Keywords：

radical resection of hilar cholangiocarcinoma; hemorrhage; treatment; prevention

DOI：

10.7507/1007-9424.201707061

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the strategy of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma. Method Reviewing the related literatures at home and abroad in recent years, to summarize the progress of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma. Results We should clear the postoperative bleeding time, extent, cause, and location, to help the clinician to choose the appropriate timing of intervention and treatment. The patients with early hemorrhage and mild degree hemorrhage could be treated conservatively. If patients with severe hemorrhage and hemodynamic disorders, surgical intervention must be decisive. Patients with late hemorrhage would have serious consequences, and these patients should receive interventional or surgical treatment as early as possible. Conclusions For patients with hilar cholangiocarcinoma after radical resection, doctors need to do accurate preoperative evaluation, meticulous operation, and intensive management after operation, to reduce the incidence of hemorrhage after radical resection of hilar cholangiocarcinoma. If the postoperative hemorrhage occurs, the cause, location, time, and degree of hemorrhage should be clearly defined to facilitate clinicians to make rapid clinical decisions and to develop treatment programs.

Citation： YANG Jianming, CHEN Ziyang, GAO Feng. The strategy of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(2): 235-241. doi: 10.7507/1007-9424.201707061 Copy

1.	董家鴻. 弘揚志強精神開創精準膽道外科的新時代. 中華消化外科雜志, 2016, 15(4): 307-309.
2.	Nagino M, Ebata T, Yokoyama Y, et al. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg, 2013, 258(1): 129-140.
3.	Chevrou-Séverac H, Pinget C, Cerantola Y, et al. Cost-effectiveness analysis of immune-modulating nutritional support for gastrointestinal cancer patients. Clin Nutr, 2014, 33(4): 649-654.
4.	Yubin L, Chihua F, Zhixiang J, et al. Surgical management and prognostic factors of hilar cholangiocarcinoma: experience with 115 cases in China. Ann Surg Oncol, 2008, 15(8): 2113-2119.
5.	陳孝平. 肝門部膽管癌外科治療的前景與挑戰. 腹部外科, 2010, 23(2): 68-69.
6.	Imamura H, Seyama Y, Kokudo N, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg, 2003, 138(11): 1198-1206.
7.	Poon RT, Fan ST, Lo CM, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1 222 consecutive patients from a prospective database. Ann Surg, 2004, 240(4): 698-708.
8.	Asiyanbola B, Chang D, Gleisner AL, et al. Operative mortality after hepatic resection: are literature-based rates broadly applicable? J Gastrointest Surg, 2008, 12(5): 842-851.
9.	Kooby DA, Stockman J, Ben-Porat L, et al. Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg, 2003, 237(6): 860-869.
10.	Wei AC, Tung-Ping Poon R, Fan ST, et al. Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma. Br J Surg, 2003, 90(1): 33-41.
11.	劉連新, 尹大龍. 肝癌肝切除術后常見并發癥與處理. 中華普外科手術學雜志 (電子版), 2014, 8(1): 23-25.
12.	Yang T, Li L, Zhong Q, et al. Risk factors of hospital mortality after re-laparotomy for post-hepatectomy hemorrhage. World J Surg, 2013, 37(10): 2394-2401.
13.	Lim C, Dokmak S, Farges O, et al. Reoperation for post-hepatectomy hemorrhage: increased risk of mortality. Langenbecks Arch Surg, 2014, 399(6): 735-740.
14.	Rahbari NN, Garden OJ, Padbury R, et al. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB (Oxford), 2011, 13(8): 528-535.
15.	Nomi T, Fuks D, Govindasamy M, et al. Risk factors for complications after laparoscopic major hepatectomy. Br J Surg, 2015, 102(3): 254-260.
16.	羅祥基, 張柏和. 肝門部膽管癌術后嚴重并發癥的防治. 實用腫瘤雜志, 2007, 22(2): 175-177.
17.	邢寶才, 徐達. 肝切除術后出血的診療策略. 肝癌電子雜志, 2015, 2(1): 25-28.
18.	胡驍, 胡維昱, 孫傳東, 等. 肝門部膽管癌根治性切除術后并發癥的診斷和治療. 中國現代普通外科進展, 2015, 18(4): 328-330.
19.	李相成, 季顧惟. 肝門部膽管癌的根治性切除. 外科理論與實踐, 2017, 22(3): 185-190.
20.	尹大龍, 劉連新. 肝門部膽管癌根治性切除術前評估策略. 肝膽外科雜志, 2017, 25(2): 84-86.
21.	Ni Q, Wang H, Zhang Y, et al. MDCT assessment of resectability in hilar cholangiocarcinoma. Abdom Radiol (NY), 2017, 42(3): 851-860.
22.	Madhusudhan KS, Gamanagatti S, Gupta AK. Imaging and interventions in hilar cholangiocarcinoma: a review. World J Radiol, 2015, 7(2): 28-44.
23.	Zeng N, Tao H, Fang C, et al. Individualized preoperative planning using three-dimensional modeling for Bismuth and Corlette type Ⅲ hilar cholangiocarcinoma. World J Surg Oncol, 2016, 14(1): 44.
24.	陳康, 熊力, 鄭硯文. 3D 打印技術在肝臟外科應用現狀及展望. 中國普通外科雜志, 2017, 26(1): 90-95.
25.	Lambrecht JT, Berndt DC, Schumacher R, et al. Generation of three-dimensional prototype models based on cone beam computed tomography. Int J Comput Assist Radiol Surg, 2009, 4(2): 175-180.
26.	Shirabe K, Kajiyama K, Harimoto N, et al. Risk factors for massive bleeding during major hepatectomy. World J Surg, 2010, 34(7): 1555-1562.
27.	Yang T, Zhang J, Lu JH, et al. A new staging system for resectable hepatocellular carcinoma: comparison with six existing staging systems in a large Chinese cohort. J Cancer Res Clin Oncol, 2011, 137(5): 739-750.
28.	Gawande AA, Kwaan MR, Regenbogen SE, et al. An Apgar score for surgery. J Am Coll Surg, 2007, 204(2): 201-208.
29.	劉養歲, 張昕輝, 李歡送, 等. 外科 Apgar 評分對肝門部膽管癌患者術后風險的評估作用. 臨床外科雜志, 2017, 25(6): 426-429.
30.	中國抗癌協會. 肝門部膽管癌規范化診治專家共識 (2015). 中華肝膽外科雜志, 2015, 21(8): 505-511.
31.	Gupta D, Vashi PG, Lammersfeld CA, et al. Role of nutritional status in predicting the length of stay in cancer: a systematic review of the epidemiological literature. Ann Nutr Metab, 2011, 59(2/4): 96-106.
32.	郭劍, 周永斌, 翟澤民, 等. 肝門部膽管癌患者營養不良評估與術后發癥的相研究. 中華全科醫學, 2016, 14(8): 1266-1268.
33.	李澄云, 牛秀峰, 倪家連. 術前減黃對肝門部膽管癌手術效果的影響. 肝膽胰外科雜志, 2017, 29(3): 203-206.
34.	殷曉煜. 肝門部膽管癌手術治療的熱點與難點. 中華肝臟外科手術學電子雜志, 2017, 6(2): 81-84.
35.	王輝, 王堅, 王昊陸, 等. 影響肝門部膽管癌術后生存率的多因素分析. 外科理論與實踐, 2014, 19(5): 444-448.
36.	董家鴻, 鄭樹森, 陳孝平, 等. 肝切除術前肝臟儲備功能評估的專家共識 (2011 版). 中華消化外科雜志, 2011, 10(1): 20-25.
37.	晏益核, 黃玉斌, 蔡小勇. 肝門部膽管癌的外科治療現狀. 中國普通外科雜志, 2017, 26(2): 246-251.
38.	Furusawa N, Kobayashi A, Yokoyama T, et al. Surgical treatment of 144 cases of hilar cholangiocarcinoma without liver-related mortality. World J Surg, 2014, 38(5): 1164-1176.
39.	齊衛鵬, 王劍明, 張劍, 等. 聯合血管切除重建在肝門部膽管癌根治術中的應用 (附 16 例病例分析). 中國醫師進修雜志, 2016, 39(7): 627-630.
40.	Carless PA, Henry DA, Anthony DM. Fibrin sealant use for minimising peri-operative allogeneic blood transfusion. Cochrane Database Syst Rev, 2003, (2): CD004171.
41.	Boonstra EA, Molenaar IQ, Porte RJ, et al. Topical haemostatic agents in liver surgery: do we need them? HPB (Oxford), 2009, 11(4): 306-310.
42.	馮金鴿, 鄭曉燕, 安琳, 等. 加速康復外科在肝門部膽管癌手術患者中的應用. 臨床醫學研究與實踐, 2016, 1(15): 143-145.
43.	中國研究型醫院學會肝膽胰外科專業委員會. 肝膽胰外科術后加速康復專家共識 (2015 版). 中華消化外科雜志, 2016, 15(1): 1-6.
44.	Balzan S, Belghiti J, Farges O, et al. The " 50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg, 2005, 242(6): 824-828.
45.	中華醫學會外科學分會外科手術學學組. 肝切除術后加速康復中國專家共識 (2017 版) 臨床肝膽病雜志, 2017, 33(10): 1876-1882.
46.	張永杰, 邱應和, 沈寧佳. 膽胰外科術后遲發型性出血的介入治療. 中華肝臟外科手術學電子雜志, 2017, 6(3): 164-167.
47.	Fujii Y, Shimada H, Endo I, et al. Management of massive arterial hemorrhage after pancreatobiliary surgery: does embolotherapy contribute to successful outcome? J Gastrointest Surg, 2007, 11(4): 432-438.
48.	Rau C, Blanc B, Ronot M, et al. Neither preoperative computed tomography nor intra-operative examination can predict metastatic lymph node in the hepatic pedicle in patients with colorectal liver metastasis. Ann Surg Oncol, 2012, 19(1): 163-168.
49.	Beyer L, Bonmardion R, Marciano S, et al. Results of non-operative therapy for delayed hemorrhage after pancreaticoduodenectomy. J Gastrointest Surg, 2009, 13(5): 922-928.
50.	Aragon RJ, Solomon NL. 肝臟切除技術. 中國普通外科雜志, 2013, 22(7): 818-827.
51.	Richardson AJ, Laurence JM, Lam VW. Portal triad clamping versus other methods of vascular control in liver resection: a systematic review and meta-analysis. HPB (Oxford), 2012, 14(6): 355-364.

1. 董家鴻. 弘揚志強精神開創精準膽道外科的新時代. 中華消化外科雜志, 2016, 15(4): 307-309.
2. Nagino M, Ebata T, Yokoyama Y, et al. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg, 2013, 258(1): 129-140.
3. Chevrou-Séverac H, Pinget C, Cerantola Y, et al. Cost-effectiveness analysis of immune-modulating nutritional support for gastrointestinal cancer patients. Clin Nutr, 2014, 33(4): 649-654.
4. Yubin L, Chihua F, Zhixiang J, et al. Surgical management and prognostic factors of hilar cholangiocarcinoma: experience with 115 cases in China. Ann Surg Oncol, 2008, 15(8): 2113-2119.
5. 陳孝平. 肝門部膽管癌外科治療的前景與挑戰. 腹部外科, 2010, 23(2): 68-69.
6. Imamura H, Seyama Y, Kokudo N, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg, 2003, 138(11): 1198-1206.
7. Poon RT, Fan ST, Lo CM, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1 222 consecutive patients from a prospective database. Ann Surg, 2004, 240(4): 698-708.
8. Asiyanbola B, Chang D, Gleisner AL, et al. Operative mortality after hepatic resection: are literature-based rates broadly applicable? J Gastrointest Surg, 2008, 12(5): 842-851.
9. Kooby DA, Stockman J, Ben-Porat L, et al. Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg, 2003, 237(6): 860-869.
10. Wei AC, Tung-Ping Poon R, Fan ST, et al. Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma. Br J Surg, 2003, 90(1): 33-41.
11. 劉連新, 尹大龍. 肝癌肝切除術后常見并發癥與處理. 中華普外科手術學雜志 (電子版), 2014, 8(1): 23-25.
12. Yang T, Li L, Zhong Q, et al. Risk factors of hospital mortality after re-laparotomy for post-hepatectomy hemorrhage. World J Surg, 2013, 37(10): 2394-2401.
13. Lim C, Dokmak S, Farges O, et al. Reoperation for post-hepatectomy hemorrhage: increased risk of mortality. Langenbecks Arch Surg, 2014, 399(6): 735-740.
14. Rahbari NN, Garden OJ, Padbury R, et al. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB (Oxford), 2011, 13(8): 528-535.
15. Nomi T, Fuks D, Govindasamy M, et al. Risk factors for complications after laparoscopic major hepatectomy. Br J Surg, 2015, 102(3): 254-260.
16. 羅祥基, 張柏和. 肝門部膽管癌術后嚴重并發癥的防治. 實用腫瘤雜志, 2007, 22(2): 175-177.
17. 邢寶才, 徐達. 肝切除術后出血的診療策略. 肝癌電子雜志, 2015, 2(1): 25-28.
18. 胡驍, 胡維昱, 孫傳東, 等. 肝門部膽管癌根治性切除術后并發癥的診斷和治療. 中國現代普通外科進展, 2015, 18(4): 328-330.
19. 李相成, 季顧惟. 肝門部膽管癌的根治性切除. 外科理論與實踐, 2017, 22(3): 185-190.
20. 尹大龍, 劉連新. 肝門部膽管癌根治性切除術前評估策略. 肝膽外科雜志, 2017, 25(2): 84-86.
21. Ni Q, Wang H, Zhang Y, et al. MDCT assessment of resectability in hilar cholangiocarcinoma. Abdom Radiol (NY), 2017, 42(3): 851-860.
22. Madhusudhan KS, Gamanagatti S, Gupta AK. Imaging and interventions in hilar cholangiocarcinoma: a review. World J Radiol, 2015, 7(2): 28-44.
23. Zeng N, Tao H, Fang C, et al. Individualized preoperative planning using three-dimensional modeling for Bismuth and Corlette type Ⅲ hilar cholangiocarcinoma. World J Surg Oncol, 2016, 14(1): 44.
24. 陳康, 熊力, 鄭硯文. 3D 打印技術在肝臟外科應用現狀及展望. 中國普通外科雜志, 2017, 26(1): 90-95.
25. Lambrecht JT, Berndt DC, Schumacher R, et al. Generation of three-dimensional prototype models based on cone beam computed tomography. Int J Comput Assist Radiol Surg, 2009, 4(2): 175-180.
26. Shirabe K, Kajiyama K, Harimoto N, et al. Risk factors for massive bleeding during major hepatectomy. World J Surg, 2010, 34(7): 1555-1562.
27. Yang T, Zhang J, Lu JH, et al. A new staging system for resectable hepatocellular carcinoma: comparison with six existing staging systems in a large Chinese cohort. J Cancer Res Clin Oncol, 2011, 137(5): 739-750.
28. Gawande AA, Kwaan MR, Regenbogen SE, et al. An Apgar score for surgery. J Am Coll Surg, 2007, 204(2): 201-208.
29. 劉養歲, 張昕輝, 李歡送, 等. 外科 Apgar 評分對肝門部膽管癌患者術后風險的評估作用. 臨床外科雜志, 2017, 25(6): 426-429.
30. 中國抗癌協會. 肝門部膽管癌規范化診治專家共識 (2015). 中華肝膽外科雜志, 2015, 21(8): 505-511.
31. Gupta D, Vashi PG, Lammersfeld CA, et al. Role of nutritional status in predicting the length of stay in cancer: a systematic review of the epidemiological literature. Ann Nutr Metab, 2011, 59(2/4): 96-106.
32. 郭劍, 周永斌, 翟澤民, 等. 肝門部膽管癌患者營養不良評估與術后發癥的相研究. 中華全科醫學, 2016, 14(8): 1266-1268.
33. 李澄云, 牛秀峰, 倪家連. 術前減黃對肝門部膽管癌手術效果的影響. 肝膽胰外科雜志, 2017, 29(3): 203-206.
34. 殷曉煜. 肝門部膽管癌手術治療的熱點與難點. 中華肝臟外科手術學電子雜志, 2017, 6(2): 81-84.
35. 王輝, 王堅, 王昊陸, 等. 影響肝門部膽管癌術后生存率的多因素分析. 外科理論與實踐, 2014, 19(5): 444-448.
36. 董家鴻, 鄭樹森, 陳孝平, 等. 肝切除術前肝臟儲備功能評估的專家共識 (2011 版). 中華消化外科雜志, 2011, 10(1): 20-25.
37. 晏益核, 黃玉斌, 蔡小勇. 肝門部膽管癌的外科治療現狀. 中國普通外科雜志, 2017, 26(2): 246-251.
38. Furusawa N, Kobayashi A, Yokoyama T, et al. Surgical treatment of 144 cases of hilar cholangiocarcinoma without liver-related mortality. World J Surg, 2014, 38(5): 1164-1176.
39. 齊衛鵬, 王劍明, 張劍, 等. 聯合血管切除重建在肝門部膽管癌根治術中的應用 (附 16 例病例分析). 中國醫師進修雜志, 2016, 39(7): 627-630.
40. Carless PA, Henry DA, Anthony DM. Fibrin sealant use for minimising peri-operative allogeneic blood transfusion. Cochrane Database Syst Rev, 2003, (2): CD004171.
41. Boonstra EA, Molenaar IQ, Porte RJ, et al. Topical haemostatic agents in liver surgery: do we need them? HPB (Oxford), 2009, 11(4): 306-310.
42. 馮金鴿, 鄭曉燕, 安琳, 等. 加速康復外科在肝門部膽管癌手術患者中的應用. 臨床醫學研究與實踐, 2016, 1(15): 143-145.
43. 中國研究型醫院學會肝膽胰外科專業委員會. 肝膽胰外科術后加速康復專家共識 (2015 版). 中華消化外科雜志, 2016, 15(1): 1-6.
44. Balzan S, Belghiti J, Farges O, et al. The " 50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg, 2005, 242(6): 824-828.
45. 中華醫學會外科學分會外科手術學學組. 肝切除術后加速康復中國專家共識 (2017 版) 臨床肝膽病雜志, 2017, 33(10): 1876-1882.
46. 張永杰, 邱應和, 沈寧佳. 膽胰外科術后遲發型性出血的介入治療. 中華肝臟外科手術學電子雜志, 2017, 6(3): 164-167.
47. Fujii Y, Shimada H, Endo I, et al. Management of massive arterial hemorrhage after pancreatobiliary surgery: does embolotherapy contribute to successful outcome? J Gastrointest Surg, 2007, 11(4): 432-438.
48. Rau C, Blanc B, Ronot M, et al. Neither preoperative computed tomography nor intra-operative examination can predict metastatic lymph node in the hepatic pedicle in patients with colorectal liver metastasis. Ann Surg Oncol, 2012, 19(1): 163-168.
49. Beyer L, Bonmardion R, Marciano S, et al. Results of non-operative therapy for delayed hemorrhage after pancreaticoduodenectomy. J Gastrointest Surg, 2009, 13(5): 922-928.
50. Aragon RJ, Solomon NL. 肝臟切除技術. 中國普通外科雜志, 2013, 22(7): 818-827.
51. Richardson AJ, Laurence JM, Lam VW. Portal triad clamping versus other methods of vascular control in liver resection: a systematic review and meta-analysis. HPB (Oxford), 2012, 14(6): 355-364.

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The strategy of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma

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