晚期阻塞性黄疸减黄术式选择  

Palliative operation procedures for late obstructive jaundice

作　　者：梁刚[1] 傅炯 晁明[1] 韩晞[1] 陈健[1] 林汉庭[1] 

机构地区：[1]浙江大学医学院附属二院外科,杭州市310009 [2]浙江奉化市人民医院介入科,315500

出　　处：《中华肝胆外科杂志》2002年第12期732-735,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的　了解各种肝内胆管引流治疗不能切除的恶性胆道梗阻的疗效。方法　采用肝门部、胆囊床、肝表面、肝正中裂、肝方叶切除和介入治疗等方法行肝内胆管内或外引流术。结果　手术组 :肝门部入路 5 1例 ,经胆囊床入路 5例 ,经肝表面入路 2 7例 ,经肝正中裂入路 5 0例 ,肝方切除 10例 ;手术行肝内胆管外流术 42例 ,行肝内胆管胆总管与空肠吻合术 47例 ,行置管架桥内引流术 5 4例。所有病人无手术死亡 ,手术成功率为 81% ,减黄效果显著 ,减黄有效率 78 3 %。术后并发症有胆漏、膈下感染、切口感染和导管堵塞。介入组 :右肝内胆管外引流 (PTCD) 7例 ,左右肝管外引流(PTCD) 10例 ,行胆管内外引流 (PTBD +PTBS) 33例 ,减黄效果显著 ,减黄有效率 80 % ,术后有胆管炎和胰腺炎发生。结论　肝内胆管引流是治疗不能切除的恶性胆道梗阻的重要方法 ,能减轻症状 ,提高生活质量和延长生命。Objective To evaluate the effect of many methods biliary drainage for unresectable obstructive jaundice. Methods External or internal drainage were made by porta of liver, fossa for gallbladder, surface of liver, middle fissure separation, partial resection of quadrate sepment or interventional. Results Access of pora of liver in 51 cases, access of fossa for sallbladder in 5 cases, access of suface of liverin 27 cases, access of middle fissure separation in 50ceass, access of partial resection of quadrate segment in 10 ceases. External drainage intrahepatic were performed in 42 cases, Biliary enteric anastomasis were performed in 47 cases. Stent implat drainage were performed in 54 cases, no-in-hospital death, The surgical operation rate was 81%. The bilrubin level fell markelly. The effective relieve jaundice of rate was 78.3%. The postoperation morbidity including biliary fistula, subdiaphragmatic, incision infection and tube block. External drainage of right intrahepatic by PTCD were performed in 7cases. External drainage right and left of intrahepatic by PTCD were maded in 10 cases. PTCD and PTBS (stent implantation) were maded in 33 cases. the bilrubin level feel markelly. The effective relieve jaundice of rate was 80%. The main complications in cluding cholangitis and pancreatitis. Comclusions Surgical biliary drainage plays an important method in relieving symptoms, improving life quality and prolonging life time for unresectable malignant bile obstruction.

关 键 词：晚期阻塞性黄疸 恶性胆道梗阻 手术治疗 手术方式 

分 类 号：R657.4[医药卫生—外科学]