426例胆肠吻合术式的选择与临床疗效分析

Evaluation of therapeutic effects of bilioenterostomy:reported of 426 cases

目的探讨和分析对梗阻性黄疸患者行胆肠吻合术式的选择与疗效。方法对１９９３年１月～１９９８年１月所行胆肠吻合术的４２６例梗阻性黄疸病例进行总结。原发疾病包括：结石并高位胆管狭窄２３６例（５６％）、晚期壶腹周围癌９８例（２３％）、肝门部胆管癌６４例（１５％）和胆总管囊肿２８例（６％）。其治疗目的一类系病变切除后的胆道重建，另一类是晚期肿瘤的姑息性引流。吻合的方式有：１６０例（３７％）行肝外或肝门部胆管空肠吻合术；２６６例（６３％）采用肝内胆管空肠吻合术，其中经肝圆韧带径路左侧吻合３４例（８％）；经胆囊床右侧吻合１５例（４％），其余采用肝叶肝段切除断面的胆肠内引流。结果术后近期和１～６年的随访表明，不同的病例选用适当的胆肠吻合术式可达到有效解除黄疸的目的。结论正确的术式选择是有效引流、缓解梗阻性黄疸的基本保证。

Objectives To investigate the selection of the types of anastomosis and to evaluate the therapeutic effects of bilioenterostomy. Methods From 1993 to 1998, 426 patients with obstructive jaundice underwent bilioenterostomy. The patients included 236 cases (56%) of hilar strictures in hepatolithiasis, 98 cases(23%) of end stage periampullary tumors, 64 cases(15%) of proximal cholangiocarcinoma, and 28 cases (6%) of congenital choledochus cyst.Reconstruction of biliary tract was performed after resection of affected duct or palliative bypass for end stage carcinoma. The types of anastomosis included extra or hilar hepatic bilioenterostomy (160 cases,37%), and intra hepatic duct anastomosis with different type of hepatectomy (266 cases,63%), in which anastomosis was performed by round ligament approch (34 cases,8%),and anastomosis through gallbladder fossa (15 cases,4%). Results Short and 1 6 year follow up showed that jaundice of patients was completely relieved by suitable type of bilioenterostomy. Conclusions The good therapeutic effects of bilioenterostomy are based on the correct selection of anastomosis methods.