胆道恶性肿瘤术中胆肠吻合规范应用

Standard application of bilioenterostomy for malignant biliary neoplasms

胆道恶性肿瘤实施手术治疗时,除部分比较早期的胆囊癌和病灶局限于一侧肝叶、尚未累及肝门胆管的肝内胆管癌之外,多数病例均需联合肝门胆管或肝外胆管切除,附加胆肠重建。外科医生应掌握胆肠吻合在肝外胆管切除、肝中央部联合尾状叶切除、半肝联合尾叶切除及姑息性手术等胆道恶性肿瘤不同手术方法中的具体应用,胰十二指肠切除术时胆肠吻合应注意的问题以及"肝门空肠吻合"的概念和运用。

Resection of hilar or extrahepatic bile duct with bilioenterostomy is a common procedure in surgeries for malignant biliary neoplasms in most of the cases, except for some of the early-staged cholieystocarcinoma and unilateral intrahepatic cholangiocareinoma without involvement of the porta hepatis. Applications of bilioenterostomy in situations like resection of hilar or extrahepatic bile duct, combined resection of the central part of the liver together with the caudate lobe, hemihepatectomy with resection of the caudate lobe, and palliative operations are the focuses surgeons need tomaster. In addition, some technical hints of biliojejunostomy in pancreaticoduodenectomy, and the concept and application of ＂hilar biliojejunostomy＂ are needed to be paid attention to.