晚期肝门胆管癌的经腹减黄治疗

目的 总结晚期肝门胆管癌减黄治疗的经验。方法 对43例晚期肝门胆管癌施行不同的内引流术并进行分析及随访。结果 术后并发应激性溃疡出血37例，无胆瘘及腹腔感染，无死亡病例，术后两周黄疸明显减轻30例，完全消退7例，随访36例，术后生存期最短4个月，最长43个月，至今存活6例，生存期分别达21、16、11、9、8和7个月。结论 术前影像检查为术式的选择提供直接的依据；术式选择视患者营养状况及梗阻部位和术中探查情况而定，置管架桥内引流术操作简单，肝断面空肠Roux-Y吻合减黄效果好。

TREATMENT OF JAUNDICE IN PATIENTS WITH ADVANCED HILAR CHOLANGIOCARCINOMA BY OPEATION

Objective To summarize the experience on treating jaundice in patients with advanced hilar cholangiocarcinoma(AHCC) by operation.Methods 43 cases with AHCC underwent different internal drainage operation respectively were analyzed,admitted to our hospital from Jan.1996 to Jan.2001.36 cases of them were followed up after operation.ResultsAbove all cases,it occurred stress ulcer hemorrhage in 37 cases;there were no postoperative deaths as well as bile fistula and abdominal infection.In two weeks after operation,the jaundice decreased significantly in 30 cases and disappeared completely in 7 cases.The shortest survival time was no more than 4 months and the longest for 43 months after fortnight.Up to now,6 cases are still alive for 21,16,11,9,8 and 7 months respectively. Conclusion The preoperational examination of image can present direct evidence for us to select proper operative ways.Besides this,the surgical methods depend on patient's general condition,obstructive site of bile duct,intraoperative exploration and so on.The simplest method to relieve jaundice is internal drainage through placing tube to build bridge,and the most effective way is Roux Y hepatojejunostomy between hepatic fracture and intestines.