12例重症胆道炎合并门静脉海绵样变的外科治疗

Surgical treatment of the severe cholangeitis associated with cavernous transformation of the portal vein:A report of 12 cases

目的探讨重症胆道炎合并门静脉海绵样变时的手术方法。方法经穿刺、胆囊管造影或胆道探子等确定胆总管位置及走向,采用两边纵行缝扎中间切开的方法,沿胆道长轴纵行切开。结果本组12例,一期手术治愈11例。经3～72个月随访,9例无任何症状,B超检查未发现结石。3例于手术后29、31、40个月复查发现胆总管有结石存在,经十二指肠镜取石后服用消炎利胆药物等,B超检查未再发现结石。结论这是一种最基本有效的方法,达到了满意的临床治疗效果。

Objective To explore the surgical technique of the severe cholangeitis associated with cavernous transformation of the portal vein （PVCT）. Method Location of the common bile duct was confirmed with measures of puncture, cholecystocholangiogram and bile duet spy. The eholedoehendysis was conducted with techniques in which suture was taken at the two side walls along with the cut firstly and then cut was performed along with the longitudinal axis. Result Eleven eases obtained surgical healing of first intention among the 12 eases. All of the 12 cases were followed-up for 3-72 months; 9 cases were no symptoms and were not found any bile stones by B uhrasonography; the other 3 cases were found eholedocholith respectively on the 29th month, 31st month and 40th month after operation and were healed by duodenoscopic treatment and taking choleretie. Conclusion The surgical techniques are effective for treatment of the severe cholangeitis associated PVCT. The satisfying clinical effect is obtained by the surgical techniques.