Search PubMedSearch

PubMed · 740261

[Intraoperative choledochoscopy].

Abstract

Intraoperative choledochoscopy is examined and the instruments mostly employed for this purpose are described, with particular reference to the Olympus CHF B2, and personal modifications to the same, as used in the present study. The indications for the examination and the technique required are explained. It is especially useful in diseases of the bile ducts, and superior to cholangiography, which often fails to diagnose intrahepatic calculosis and small, multicentered tumours. A series of images relating to calculosis of the bile ducts, biliary neoplasia, the choledochus in lesions of the head of the pancreas, and the normal appearance of the bile ducts is presented.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

S Olivero, F Ibba, A Foco, G C Viglione. [Intraoperative choledochoscopy].. https://pubmed.ncbi.nlm.nih.gov/740261/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

[Palliative therapy of carcinomas of the biliary system].

CARCINOMA OF THE GALLBLADDER: Only patients suffering from advanced disease have symptoms, that is pain, jaundice, weight loss. Mean 5-year survival rate tends to be lower than 5%. Tumors can be resected with negative margins in 15 to 25% of the patients. Obstructive jaundice can be managed with endoscopic biliary stent in 84% of the patients. After radiotherapy tumor regression is observed in 80% of the patients. Their mean survival time is 10 months. CHOLANGIOCARCINOMAS: More than 90% of the patients present with jaundice. At the time of presentation, 50% of the patients already have metastases to lymph nodes. Mean total survival time of all patients is 12 months. Surgical resection can successfully be performed in 30 to 40% of the patients suffering from proximal cholangiocarcinomas. Distal unresectable tumors are best palliated with an endoscopically placed stent in 97.5% of the patients. Patients having undergone radiotherapy will have a mean survival time of 9 to 12 months. There is a 12% response rate after chemotherapy with single agents and one of 23% after combined regimens. Intraarterial application of chemotherapy results in 44% response rate. CONCLUSION: Carcinomas of the biliary tract are often diagnosed at advanced inoperable stages. Patients quality of life can be ameliorated by palliative treatment, i.e. biliary stents, radio-, chemotherapy. Mean survival time does normally not exceed 1 year.

Bile Duct Neoplasms

[Pre- and postoperative irradiation in the treatment of resectable Klatskin tumours].

Proximal bile duct carcinoma (Klatskin tumour) is infrequent and difficult to treat. In principle, surgery is indicated. The usefulness of irradiation after resection is controversial in the literature. This article describes the experiences gained in the Academic Medical Centre of Amsterdam with pre- and postoperative irradiation of resectable Klatskin tumours. Preoperative irradiation (10.5 Gy) is administered to devitalize detached tumour cells in the bile, to prevent implantation metastases after resection. Postoperative irradiation has been administered since 1986 according to protocol. An analysis of 71 patients, of whom 48 had been irradiated after resection while 23 had not, showed a statistically significant prolongation of survival in the group irradiated postoperatively. Radiotherapy was administered externally (55 Gy) or in combination with internal radiotherapy (45 Gy external, 10 Gy internal). For internal irradiation, the source of radiation (Iridium-192) was introduced along the bile duct anastomoses via the soma formed by the blind end of the Roux-Y jejunal loop used for bile duct reconstruction. Since internal irradiation in combination with external irradiation caused more complications, while there was no difference of survival from patients only irradiated externally, the complete postoperative irradiation is currently being given from the outside. Pre- and postoperative irradiation may contribute to the success of the treatment of the resectable Klatskin tumour.

Bile Duct Neoplasms