肝门部胆管癌的外科治疗(附22例报告)

Surgical treatment of hilar bile duct carcinoma

２２例病人中，肝门周围胆管切除，左右肝管残端与空肠ＲｏｕｘＹ吻合１５例；肝门周围胆管及左半肝切除，右肝管残端与空肠吻合３例；肝门周围胆管及左半肝、左尾叶切除，右肝二、三级肝管与空肠吻合２例；右肝门套入近端空肠２例。术后生存不满一年５例，２年±６月１１例，３年５例，５年以上１例。推崇重视Ｂ超检查，推崇首先于胰头上缘切断胆总管，再向上解剖的手术顺序。肝断面上相邻肝胆管应施行拼接处理。若肝管数目多且口径小时，胆管内置支撑管，行肝门套入肠腔的吻合，更为安全可靠。

Twentytwo patients(pts) with hilar bile duct carcinoma underwent the operationAmong them,15 pts were performed with removal of bile ducts at the hilum,and the stump of left and right billaryjejunal RouxY anastomosis;3 pts with left lobectomy,the stump of right biliaryjejunal ananstomosis,2 pts with left and caudate lobectomy,Ⅱ and Ⅲ right intrahepatic biliaryjejunal anastomosis,and 2 pts with right hepatic portal enclosed by proximal jejunumDuring the followup,5 pts survived for less than 12 months,11 pts 24±6 months,5 pts 3 years and 1 patient still alive 5 years after the operationB ultrasonography examination played an important role in the preoperative diagnosisIt is better to cut off bile duct on the upper edge of the head of pancreas at the early stage of operation,and then dissect upwardsThey suggest that the apposition of neighbouring hepatobiliary ducts in the plane of liver be performedIt is more secure to place a supportive tube into the bile ducts,and perform the anastomosis between the liver and the intestine by which the hepatic portal is enclosed,when there are too many hepatobiliary ducts and the diameter of them is too small