肝门胆管梗阻的外科治疗(附21例报告)

Surgical treatment of billiary obstruction at hepatic hilum.

从1991年至1993年作者诊治22例肝门胆管梗阻,其中15例恶性梗阻,7例良性梗阻。经反复应用B-us检查确定近端、远端胆管受阻受累的部位。术前总胆红素高达100～865μmol/L,直接胆红素35～271μmol/L。分别有7例除保护肝功和营养支持外不作术前减黄处置。外科治疗包括受累肝段或防碍显露肝门胆管的肝段的切除,肝门胆管切除及胆汁的内外转流术。切除第7～10肋软骨可显著改善肝门胆管的显露并方便胆肠吻合。本组无手术死亡。15例恶性梗阻中3例分别生存2～6月和7～12月,9例仍存活。7例良性梗阻中除1例有胆总管残石偶发返流性胆管炎外余皆无胆管炎复发。

22 patients with biliary obstruction at hepatic hilum was treated from 1991 to 1993, in which 15 cases were malignant obstruction and 7 cases were benign obstruction. The proximal and distal sites of biliary obstruction were detected by repeat B-us investigation. The surgical treatments include resection of hepatic segment which were invaded by the cancer or impeded surgical approach to hilar bile duct from enlarged Ⅳ hepatic segment, resection of hilar bile duct with internal or external drainage of bile. The removing of Ⅶ-Ⅹ costal cartilages could facilitate the exposure of hilar bile duct and cholangio jejunostomy remarkably. There is no operative mortality. In 15 malignant obstruction, 3 cases survived for 2-6 months, and 3 cases for 7-12 months, 9 cases the are still alive. There are no retrograd recurrent cholangitis in benign obstruction except 1 case with residual stones in the common bile duct.