围肝门部分肝切除处理高位胆道良恶性狭窄

目的 探讨以围绕第一肝门的经肝途径处理高位胆道狭窄的技术方法.方法 本组25例,其中良性胆道狭窄16例,恶性狭窄9例,围绕第一肝门行部分肝切除,去除或旷置病变胆管,到达健康近侧肝管后重建胆汁流出道,对治疗结果进行回顾性分析.结果 本组无住院死亡.5例病人出现包括应激性溃疡出血、膈下感染、十二指肠漏在内的并发症.所有病人黄疸均完全消退.结论 围绕第一肝门行部分肝切除,可更为有效地处理高位胆道病变,并可更直接地到达健康的近侧胆管以重建胆道,以获得更好的远期疗效.

Perihilar partial hepatectomy for management of high biliary tract benign/malignant stricture

Objective To assess the techniques of perihilar partial hepatectomy for high biliary tract stricture.Methods Twenty-five cases of benign(n=16)or malignant(n=9)biliary tract stric- ture were included in this study.Perihilar irregular hepatectomy was performed to access the proximal intrahepatic bile duct.Relevant techniques were applied to manage the benign or malignant bile duct strictures and restore the bile outflow route.Then the results were retrospectively analyzed.Results No hospital death was found in this group of patients.Severe complications including stress ulcerous bleeding,abscess of the subhepatic space,fistula of the duodenum were noted in 5 cases.Jaundice was completely subsided in all the patients.Conclusions Perihilar partial hepatectomy is helpful to manage high biliary strictures and can more effectively access the healthy proximal bile duct,which is critical for long-term outcome after biliary tract reconstruction in malignant or benign high biliary stricture.