Recently, the Department of Hepatobiliary Surgery, Jinghua Campus of the First Affiliated Hospital of Henan University of Science and Technology, received a 60-year-old patient, Mr. Li, who had symptoms such as yellowing and itchy all over his body a week ago.

Dahe Daily·Yu Video Reporter Gao Ju Correspondent Xiao Lizhen Zhang Jing

Recently, the Department of Hepatobiliary Surgery, Jinghua Campus, the Department of Hepatobiliary Surgery, Jinghua Campus, received a 60-year-old patient, Mr. Li (pseudonym), who had yellowing and itchy all over his body a week ago. "The body is so itchy that I can't stand it. I don't know when my whole body turns yellow and my urine is like soy sauce." Mr. Li said distressedly.

The department director Sun Junjun treated the patient, and based on the patient's progressive aggravation of jaundice , it was judged that it was likely to be a malignant tumor. After examination, Mr. Li's blood bilirubin level has exceeded 400μmol/L, and the imaging and laboratory results indicate that hilar cholangiocarcinoma .

According to Sun Junjun, hilar cholangiocarcinoma is a common malignant tumor in the biliary hilar system. It is insensitive to chemotherapy and radiotherapy, and the effect of immunity and targeted treatment is inaccurate. Radical surgery is the only possible cure for patients. However, due to its special anatomical location, hilar cholangiocarcinoma of the hilar area is prone to invade blood vessels, nerves, lymphoid tissue and adjacent liver tissue in the hilar area, and grow longitudinally into the bile duct lumen to form obstructive jaundice , resulting in hyperbilirubinemia, causing damage to the patient's liver and other organs throughout the body. On the other hand, the local anatomy of the hilar area is complex and the surgery requires high accuracy. Therefore, it has always been one of the extremely challenging and highly concerned difficult diseases in the field of surgery.

"This surgical site is too special. The liver portal is the portal for the concentrated entry and exit of portal vein , hepatic artery and hepatic bile ducts. It is closely related to each other. If you are not careful, you will cause severe bleeding in the patient." Sun Junjun said. However, if the surgery is not performed, the patient will have a survival period of about 6 months. Through sufficient communication with the patient and his family, the patient chose surgical resection.

Considering the specificity of the patient's tumor location and the high risk and difficulty of the operation, the operation was chosen to be completed using Da Vinci surgical robot . Sun Junjun told reporters that the Da Vinci surgical robot is a modern high-end surgical platform, and its design concept is to accurately perform complex surgical operations by using minimally invasive methods.

Sun Junjun (second from right) discussed the patient's condition with his colleagues

Da Vinci Robot consists of three parts: surgeon console, bedside robot arm system, and imaging system. It can broaden the doctor's field of vision and angle and reduce hand tremor. At the same time, the robot's "inner wrist" is more flexible than laparoscopy, and can operate around the target organ at different angles, work in a limited and narrow space, and operate more accurately, reducing the patient's blood loss and tissue trauma and postoperative adhesions caused by intraoperative tissue trauma and inflammatory reactions.

After sufficient preparation, the operation was carried out smoothly. Rapid pathology during the operation showed that there was no tumor invasion at the far and near end of the bile duct, and local lymphoid tissue was skeletalized, and the operation was relatively successful. After the operation, under the professional care of medical staff, Mr. Li recovered well and did not experience complications such as liver insufficiency, gallbladder leakage, , and anastomotic stenosis. The patient's postoperative pathological results showed that differentiated adenocarcinoma in the hilar hepatic part, and the more than ten lymph nodes detected were negative (no cancer cells were found). At present, Mr. Li has recovered and discharged from the hospital.

"In this operation, the accuracy, flexibility and stability of the Da Vinci robot in a narrow space were fully demonstrated, providing a solid guarantee for the success of the operation." Sun Junjun said.

Sun Junjun During the operation,

Sun Junjun reminds that hilar cholangiocarcinoma is common in middle-aged and elderly people aged 50-70. Due to the special location, there is often no clinical manifestation before the bile duct is completely blocked by the tumor, which is not easy to attract the attention of patients. However, some patients will show symptoms such as poor cash, decreased appetite, greasy aversion, indigestion, and discomfort in the upper abdomen. Some patients may experience bile duct infection repeatedly. As the condition progresses, patients may experience symptoms and signs of obstructive jaundice and be accompanied by weight loss, which is also the most characteristic clinical manifestation of hilar cholangiocarcinoma.