梗阻性黄疸496例手术疗效分析

目的：探讨和分析梗阻性黄疸的术式选择及疗效。方法：对1998年1月～2004年2月所行减黄术的496例梗阻性黄疸病例进行回顾性总结,其中胆总管结石或合并下端狭窄292例（59％）,左肝管并肝总管结石146例（30％）,壶腹周围癌20例（4％）,肝门部胆管癌13例（3％）,胆总管囊肿10例（2％）,胆管损伤9例（2％）,Mrizzi综合征6例（1％）。本组273例（55％）行胆总管探查加“T”管引流术或狭窄成形术,162例（33％）行胆肠吻合术,50例（10％）行左肝叶切除、肝门部胆管胆肠吻合术,11例（2％）行胰十二指肠切除术（Whipple手术）。结果：不同的病例选择恰当的术式可达到有效解除梗阻性黄疸的目的。结论：遵守“解除梗阻、去除病灶,通畅引流”的基本原则,切除病变严重的肝脏,必要时行肝门部胆管整形、胆道镜加压冲洗、术后通畅引流并用中药排石,是防止复发、提高手术疗效的关键。

The Curative Effect of Surgical Therapy for Obstructive Jaundice: Analysis of 496 Cases

Objective:To investigate the selected types of surgical therapy for obstructive jaundice and to evaluate their therapeutic effects.Methods:From 1998 to 2004,496 patients with obstructive jaundice underwent biliary drainage operation.292 patients(59%) with common bile duct stone or/and stenosis of the lower common bile duct,146 patients(30%) with left hepatic duct and common hepatic duct stone,20 patients(4%) with Periampullary Cancer,13 patients(3%) with hilar cholangiocarcinoma,10 patients(2%) with congenital choledochocyst,9 patients(2%) with biliary tract impairment,6 patients(1%) with Mrizzi syndrome.273 patients(55%) underwent exploration of the common bile duct and "T" tube drainage or plastic surgery of biliary stricture,162 patients(33%) underwent Bilioenterostomy,50 patients(10%) underwent left-sided hepatolobectomy and bilioenterostomy,11 patients(2%) underwent duodenopancreatectomy(Whipple procedure).Results:Different patients were completely relieved by suitable surgical procedures.Conclusion:The surgeons should obey the basic principle of relieving obstruction,clearing focus and draining smoothly.Removing damaged liver,performing plastic operation of biliary stricture,douching with choledochoscope,draining smoothly,removing gallbladder stone with Traditional Chinese Medicine are key points to preventing relapse and improving operational curative effects.