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.	董家鸿. 弘扬志强精神开创精准胆道外科的新时代. 中华消化外科杂志, 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.	陈孝平. 肝门部胆管癌外科治疗的前景与挑战. 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.	刘连新, 尹大龙. 肝癌肝切除术后常见并发症与处理. 中华普外科手术学杂志 (电子版), 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.	罗祥基, 张柏和. 肝门部胆管癌术后严重并发症的防治. 实用肿瘤杂志, 2007, 22(2): 175-177.
17.	邢宝才, 徐达. 肝切除术后出血的诊疗策略. 肝癌电子杂志, 2015, 2(1): 25-28.
18.	胡骁, 胡维昱, 孙传东, 等. 肝门部胆管癌根治性切除术后并发症的诊断和治疗. 中国现代普通外科进展, 2015, 18(4): 328-330.
19.	李相成, 季顾惟. 肝门部胆管癌的根治性切除. 外科理论与实践, 2017, 22(3): 185-190.
20.	尹大龙, 刘连新. 肝门部胆管癌根治性切除术前评估策略. 肝胆外科杂志, 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.	陈康, 熊力, 郑砚文. 3D 打印技术在肝脏外科应用现状及展望. 中国普通外科杂志, 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.	刘养岁, 张昕辉, 李欢送, 等. 外科 Apgar 评分对肝门部胆管癌患者术后风险的评估作用. 临床外科杂志, 2017, 25(6): 426-429.
30.	中国抗癌协会. 肝门部胆管癌规范化诊治专家共识 (2015). 中华肝胆外科杂志, 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.	郭剑, 周永斌, 翟泽民, 等. 肝门部胆管癌患者营养不良评估与术后发症的相研究. 中华全科医学, 2016, 14(8): 1266-1268.
33.	李澄云, 牛秀峰, 倪家连. 术前减黄对肝门部胆管癌手术效果的影响. 肝胆胰外科杂志, 2017, 29(3): 203-206.
34.	殷晓煜. 肝门部胆管癌手术治疗的热点与难点. 中华肝脏外科手术学电子杂志, 2017, 6(2): 81-84.
35.	王辉, 王坚, 王昊陆, 等. 影响肝门部胆管癌术后生存率的多因素分析. 外科理论与实践, 2014, 19(5): 444-448.
36.	董家鸿, 郑树森, 陈孝平, 等. 肝切除术前肝脏储备功能评估的专家共识 (2011 版). 中华消化外科杂志, 2011, 10(1): 20-25.
37.	晏益核, 黄玉斌, 蔡小勇. 肝门部胆管癌的外科治疗现状. 中国普通外科杂志, 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.	齐卫鹏, 王剑明, 张剑, 等. 联合血管切除重建在肝门部胆管癌根治术中的应用 (附 16 例病例分析). 中国医师进修杂志, 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.	冯金鸽, 郑晓燕, 安琳, 等. 加速康复外科在肝门部胆管癌手术患者中的应用. 临床医学研究与实践, 2016, 1(15): 143-145.
43.	中国研究型医院学会肝胆胰外科专业委员会. 肝胆胰外科术后加速康复专家共识 (2015 版). 中华消化外科杂志, 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.	中华医学会外科学分会外科手术学学组. 肝切除术后加速康复中国专家共识 (2017 版) 临床肝胆病杂志, 2017, 33(10): 1876-1882.
46.	张永杰, 邱应和, 沈宁佳. 胆胰外科术后迟发型性出血的介入治疗. 中华肝脏外科手术学电子杂志, 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. 肝脏切除技术. 中国普通外科杂志, 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. 董家鸿. 弘扬志强精神开创精准胆道外科的新时代. 中华消化外科杂志, 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. 陈孝平. 肝门部胆管癌外科治疗的前景与挑战. 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. 刘连新, 尹大龙. 肝癌肝切除术后常见并发症与处理. 中华普外科手术学杂志 (电子版), 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. 罗祥基, 张柏和. 肝门部胆管癌术后严重并发症的防治. 实用肿瘤杂志, 2007, 22(2): 175-177.
17. 邢宝才, 徐达. 肝切除术后出血的诊疗策略. 肝癌电子杂志, 2015, 2(1): 25-28.
18. 胡骁, 胡维昱, 孙传东, 等. 肝门部胆管癌根治性切除术后并发症的诊断和治疗. 中国现代普通外科进展, 2015, 18(4): 328-330.
19. 李相成, 季顾惟. 肝门部胆管癌的根治性切除. 外科理论与实践, 2017, 22(3): 185-190.
20. 尹大龙, 刘连新. 肝门部胆管癌根治性切除术前评估策略. 肝胆外科杂志, 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. 陈康, 熊力, 郑砚文. 3D 打印技术在肝脏外科应用现状及展望. 中国普通外科杂志, 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. 刘养岁, 张昕辉, 李欢送, 等. 外科 Apgar 评分对肝门部胆管癌患者术后风险的评估作用. 临床外科杂志, 2017, 25(6): 426-429.
30. 中国抗癌协会. 肝门部胆管癌规范化诊治专家共识 (2015). 中华肝胆外科杂志, 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. 郭剑, 周永斌, 翟泽民, 等. 肝门部胆管癌患者营养不良评估与术后发症的相研究. 中华全科医学, 2016, 14(8): 1266-1268.
33. 李澄云, 牛秀峰, 倪家连. 术前减黄对肝门部胆管癌手术效果的影响. 肝胆胰外科杂志, 2017, 29(3): 203-206.
34. 殷晓煜. 肝门部胆管癌手术治疗的热点与难点. 中华肝脏外科手术学电子杂志, 2017, 6(2): 81-84.
35. 王辉, 王坚, 王昊陆, 等. 影响肝门部胆管癌术后生存率的多因素分析. 外科理论与实践, 2014, 19(5): 444-448.
36. 董家鸿, 郑树森, 陈孝平, 等. 肝切除术前肝脏储备功能评估的专家共识 (2011 版). 中华消化外科杂志, 2011, 10(1): 20-25.
37. 晏益核, 黄玉斌, 蔡小勇. 肝门部胆管癌的外科治疗现状. 中国普通外科杂志, 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. 齐卫鹏, 王剑明, 张剑, 等. 联合血管切除重建在肝门部胆管癌根治术中的应用 (附 16 例病例分析). 中国医师进修杂志, 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. 冯金鸽, 郑晓燕, 安琳, 等. 加速康复外科在肝门部胆管癌手术患者中的应用. 临床医学研究与实践, 2016, 1(15): 143-145.
43. 中国研究型医院学会肝胆胰外科专业委员会. 肝胆胰外科术后加速康复专家共识 (2015 版). 中华消化外科杂志, 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. 中华医学会外科学分会外科手术学学组. 肝切除术后加速康复中国专家共识 (2017 版) 临床肝胆病杂志, 2017, 33(10): 1876-1882.
46. 张永杰, 邱应和, 沈宁佳. 胆胰外科术后迟发型性出血的介入治疗. 中华肝脏外科手术学电子杂志, 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. 肝脏切除技术. 中国普通外科杂志, 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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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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

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