高位胆管癌的中西医结合外科治疗

SurgicalTreatmentoflntegratedTraditionalandWesternMedicneofHepaticHilarCholan-giocarcinoma

本文报告２６例高位胆管癌患者。根据肿瘤部位分为Ⅰ、Ⅱ、Ⅲ和Ⅳ型。手术方式包括：以肿瘤为中心的肝内外胆管大范围切除后行肝肠Ｒｏｕｘ－Ｙ内引流。肿瘤局部切除，肿瘤外胆管架桥内引流，经胆囊床切开右肝内胆管行胆囊空肠吻合内引流，经肝外胆管强行通过肿瘤插管外引流等。本组手术切除率为７６．９％，明显高于其他作者的报告。我们认为，提高高位胆管癌手术切除率的关键在于早期诊断；手术方式以根治性肿瘤切除后肝肠Ｒｏｕｘ－Ｙ内引流术最佳；内引流效果明显优于外引流。在手术前后应用中药可以降低血中内毒素水平，保护肾功能，降低应激性胃粘膜病变的发生率，并可起到荡涤大肠糟粕、流通肠道和利胆消黄的功效。

nthispaper,26casesofhepatichilarcholangiocarinomawerereported.Theywereclas-sifiedintofourclinicaltypes(TypeⅠ,TypeⅡ,TypeⅢandTypeⅣ).Theoperationmethodsincluded:radicalresection(19/26),localtumorresection(1/26)internaldrainagebycatheterizationandbridging(2/26),rightintrahepaticductincisionthroughgallbladderbedandcholedocystojejunostomy(2/26),externaldrainagebycatheterizationthroughtumor(1/*?6),andetal.Theresectionrateinthisgroupwas76.9percent(20/26).Themosteffectiveoperationstyleisradicalresectionandhepaticojejunostomy.lnternaldrainagewassuperiortoexternaldrainge.TheChineseherbswereusedduringperioperativeperiod.Theycanreducetheblooden-dotoxinlevel,protectrenalfunctoinandreducetheincidenceofstomachstressulcer.