胆肠吻合术式选择与疗效分析（附426例临床分析）

作者对1992年1月～1998年1月本院为426例阻黄病例所行的胆肠吻合术进行了总结。原发疾病有复杂的肝内胆管结石并高位胆管狭窄236例(56％)、无击切除的壶腹部周围癌98例(23％)、肝门部胆管癌64例(15％)和先天性胆总管囊肿28例(6％)。其治疗目的一类系胆道病变切除、胆道狭窄修复后的胆道重建．另一类是晚期肿瘤的姑息性内日引流。吻合的方式有：126例(29％)肝外胆管空肠吻合；34例(8％)肝门部胆管空肠吻合；其余采用多种路径的肝内胆管空肠吻合：包括肝方叶切除、左或右侧肝内胆管整形、肝门胆昔空肠吻合98例(23％)；左侧肝切除、肝内胆管空肠吻合137例(32％)；右侧肝切除、肝内胆管空肠吻合16例(4％)；肝圆韧带径路左侧肝内肝管空肠吻合34例(8％)；经胆囊床行右侧肝内胆管空肠吻合15例(4％)。术后近期和1-6年的髓访结果表明．不同的阻黄病例选用适当的胆肠吻合术式可达到有效解除黄疸的目的．作者对胆肠吻合术的手术要点、术式选择等进行了讨论。

Evaluation of therapeutic effects of bilioenterostomy

From January 1992 to January 1998,426 consecutive patients presented with obstructive jaudice underwent bilioenterostomy in our hospital. The primary diseases included 236 cases (56% ) of hilar strictures in hepatolithiasis, 98 cases (23%) of end - stage periampullary tumors, 64 cases (15%) of proximal cholangiocarcinoma and 28 cases(6% ) of congenital choledochus cyst. The aim of the surgical treatment for some patients were reconstruction of biliary tract after resection of affected duct or strictured bile duct plasty, the others were palliative bypass for end - stage carcinoma. The types of anastomosis wereas follows: 126 cases (29%) extra hepatic bilioenterostomy, 34 cases (8%) hilar bilioenterostomy, others were intra - hepatic bilioenterostomy with different type of hepatectomy, which included 98 cases (23%) quadrate lobe resection and left or fight intra - hepatic bile duct plasty; 137 cases (32%) left lobectomy; 16 cases (4%) right lobectomy. Still more 34 cases (8%) left hepatic bilioenterostomy by round ligament approch,15 cases (4%) right hepatic bilienterostomy through gallbladder fossa. The result of short - term and 1-6 years lont - term follow- up indicated that the jaundice of different patients can be completed relief by suitable type of bilioenterostomy. The author also discussed the main point of the operation as well as selection the type of anastomosis.