肝外胆管畸形所致梗阻性黄疸的外科治疗探讨(附18例报告)

Surgery Management of Obstructive Jaundice Result from Malformations of Extrahepatic Biliary Duct(Report of 18 Cases)

目的探讨良性肝外胆管畸形所致梗阻性黄疸的手术治疗方法。方法按病理诊断,将18例肝外胆管畸形归类为胆总管囊肿(8例)、硬化性胆管炎(5例)、胆总管末段狭窄(3例)、胆总管壁异位胰腺(2例)。分别总结它们的临床特点、手术治疗方法及随访效果。结果8例胆总管囊肿治愈7例;5例硬化性胆管炎中,4例经十二指肠乳头行胆管扩张和支架管双向引流后,腹胀、隐痛和持续性的黄疸明显减轻;3例胆总管末段狭窄手术切除后,重建具有抗逆行性感染作用的胆肠内引流,效果良好;2例胆总管壁异位胰腺连同胆总管壁切除后,分别行胆管成形、十二指肠浆肌瓣带蒂转移修补缺损和“T”管外引流,术后腹痛、黄疸和胆道出血自止。结论良性肝外胆管畸形所致梗阻性黄疸必须手术治疗。胆总管囊肿、胆总管未段狭窄和胆总管壁异位胰腺必须行手术切除。硬化性胆管炎在寻找或切开硬化胆管有困难时,可经十二指肠乳头进行扩张和置入支架管双向引流,效果较好。

Objective To explore the surgery management for the benign obstructive jaundice from malformations of extrahepatic biliary duct. Methods 18 of such cases were collected as pathologic findings,the malformationts of extrahepatic biliary duct in the report consisted of choledochal cyst(8 cases), sclerosing cholangitis(5cases), stricture of common bile duct cend(3 cases) and heterotopic pancreas of common bile duct (2 cases), and the clinical character, the new mamagement and the results of surgery were discussed. Results Of 8 cases of choledochalcyst, 7 cases were cured. Of 5 cases sclerosing cholangitis, the abdominal distention, mild pain and interrupted jaundice were obviously improved in 4 cases underwent cholangio-expansion via duodenum papilla and drainage.For the another cases,after the resection of malformated part and reconstruction of the end of common bile duct,the abdominal pain,jaundice and hemobilia subsided. Conclusion The benign obstructive jaundice from malformations of extrahepatic biliaray duct needs suitable surgery interference according to the lesion causing obstruction