肝门部胆管癌高位切除并回盲部间置-肝门回肠吻合术2例

目的：探索肝门部胆管癌高位切除并回盲部间置－肝门回肠吻合术的临床应用。方法：对2例肝门部胆管癌患者进行详细的术前评估和充分的术前准备，行肝门部胆管癌高位切除并回盲部间置－肝门回肠吻合术，术后给予预防感染、营养支持等治疗，随访3个月，总结临床资料。结果：2例患者术后病理证实为肝门部胆管癌Bismuth IV型，术中均未输血，术后胆管支架管造影示回肠肠袢及肝内无明显气体。钡餐透视提示钡剂进入盲肠，未反流入回肠袢；口服钡剂后9h透视提示盲肠肠袢和吻合部位空肠内钡剂排出，盲肠袋黏膜皱襞有少量钡剂残留，钡剂通过回肠一结肠吻合口时无延迟及明显过快，无明显钡剂反流。2例患者随访3个月，无反流性胆管炎发生。结论：肝门部胆管癌行高位切除、回盲部间置、肝门回肠吻合术是可行的。

High resection of hilar cholangiocarcinoma combined with ileocecal segment interposition and hilar hepatoileostomy

Objective：To explore the procedure of high resection of hilar cholangiocarcinoma combined with ileocecal segment interposition and hilar hepatoileostomy. Methods： The pre-operative evaluation and preparation was carried on for two cases of hilar cholangiocarcinoma patients. High resection of hilar cholangiocarcinoma combined with ileocecal segment interposition and hilar hepatoileostomy was performed, and post-operative management was continued by infection prevention and nutrition support. The clinical data were collected and the patients were followed-up. Results There was no transfusion during operation. The pathological examination showed they were hilar cholangiocarcinoma of Bismuth Type IV. Imaging test showed no air in the interposed ileum segment. Barium contrast study demonstrated that there was no reflux to the interposed ileum, and no delaying or fasting passing of the ileocolon content through the anastomosis. There was no reflux cholangitis during the following-up of three months after operation. Conclusion： The results suggested that high resection of hilar cholangiocarcinoma combined with ileocecal segment interposition and hilar hepatoileostomy was the effective procedure,