A RESECTED CASE OF HILAR BILE DUCT CARCINOMA ASSESEDITS LOCATION BY SELECTIVE PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY AND PORTAL VENOGRAPHY

A 76-year-old female was admitted to the hospital because of icterus. She was diagnosed as having a hilar bile duct carcinoma. On admission a slightly lowered hepatic functional reserve was noted, ICGK value of 0.123. Selective percutaneous transhepatic cholangiography at 5 sites revealed that the cancer invaded the upper common bile duct, left intrahepatic bile duct, and partially right intrahepatic bile duct. Portography disclosed occlusion of the left portal vein, irregular figure of the wall of right portal trunk, and occlusion of posterior segment of branch of the portal vein. If these lesions were due to cancer invasion, standard radical operation was impossible because of patient' poor hepatic function. However, selective portal venography revealed the periphery patency and suggested minimum resection extent. Curative resection was successfully performed. Postoperative course was uneventful without liver failure. In this case selective percutaneous transhepatic cholangiography and selective percutaneous transhepatic portal venography were very useful.