三级肝管与空肠吻合治疗肝门部胆管梗阻与非外科胆管引流疗效的对比研究

The study on the effect of the tertiary hepaticojejunostomy on alleviating jaundice in treating malignant biliary duct obstruction compared with nonoperative biliary drainage

目的 观察与评价肝内三级肝管空肠吻合术治疗恶性肝门部胆管梗阻的减黄效果 ,合并症及对生存期的影响。方法 切除部分肝左外侧叶 ,解剖出左外下段支肝管或切除右前叶下段部分肝组织 ,解剖出右前下段支肝管与空肠行Roux y吻合 ,在有效减黄率 ,合并症 ,黄疸再发率及生存期等方面与三组非外科胆管引流方法PTBD、ERBD、EMBE进行对照比较。结果 手术组与经皮经肝胆管引流术 (PTBD)、经内镜逆行性胆管引流术 (ERBD)、经皮经肝自膨式金属支架术 (EMBE)。有效减黄率 :分别是 95 %、89.8%、73 %、93 % ;早期合并症发生例数 :1例 /10例 ,8例 /3 5例 ,12例 /2 1例 ,1例 /10例 ;黄疸再发率 :0 % ,5 0 % ,40 % ,0 % ;平均生存期 (天 ) :2 46 ,117.3 ,198.40 ,2 0 3 .6 ,均P <0 .0 5。结论 肝内三级肝管空肠吻合术对于不能切除的恶性肝门部胆管梗阻是确实可行的治疗方法 ,其减黄效果优于PTBD、ERBD和EMBE。

? Objective To observe and evaluate the effect of tertiary hepaticojejunostomy on alleviating jaundice in treating malignant biliary duct obstruction in the hepatic portal.Methods After left lateral segmental partial hepatectomy or right anteroinferior partial hepatectomy,the left external inferior or the right anteroinferior hepatic duct was exposed,and intrahepatic chlangio jejunostomy was performed.The effect was observed compared with that of nonoperative biliary drainage,such as endoscopic retrograde biliary drainage (N=21),expandable metal biliary endoprostheses(n=10), percutaneous transhepatic biliary drainage (n=35).Results For operation, PTBD,ERBP and EMBE group,the rate of jaundice relief was 95%,89.8%,73% and 93%,respectively;The complicantions found were 1 out of 14,8 out of 35,12 out of 21,1out of 10,respectively;The rate of recurrent jaundice was 0%,50%,40%,0%,respectively;The average survival time were 246 days,117.3 days,198.4 days and 203.6 days,respectively (P<0.05).Conclusions Being an effective method to treat the malignant biliary duct obstruction,the tertiary hepatiocjejunostomy takes PTBD,ERBD and EMBE at vantage. 〔