梗阻性黄疸临床防治新技术单中心应用研究

Clinical application of novel techniques for obstructive jaundice prevention and treatment:a single-center study

梗阻性黄疸的原因可分为良性和恶性2类。(1)良性梗阻性黄疸:胆石症、黏胆症等引起者需去除病因,医疗性胆管损伤引起者重在预防。近20年来,我们在腹腔镜胆囊切除术中宏观运用胆囊壶腹钟表定位法、胆囊废弃术2种新理念,微观运用胆囊管11类33型、胆囊动脉8种分型,确切预防了胆管损伤,避免了术后遗患梗阻性黄疸;(2)恶性梗阻性黄疸:对肝门部胆管癌导致的高位梗阻通过3D腹腔镜及肝肠吻合,提高了手术成功率。对低位梗阻施行胰十二指肠切除术中采取三级预防措施,能有效减少胰漏等并发症。对失去手术切除机会的患者,酌情选择姑息性胆汁内引流或外引流措施,可减轻黄疸,维护诸脏器功能。本文就近20年我院单中心开展的梗阻性黄疸临床防治新技术应用研究经验和成效报道如下。

The causes of obstructive jaundice can be categorized into benign and malignant etiologies.(1)Benign obstructive jaundice,such as choledocholithiasis and mucobilia,necessitates the removal of the underlying causes,with a focus on preventing iatrogenic bile duct injury.Over the past two decades,we have employed innovative techniques in laparoscopic cholecystectomy,including the macroscopic methods of ductal identification through the gallbladder infundibulum localization by an imaginary clock and the concept of gallbladder disabled technique.On a microscopic level,we have utilized a classification system of 11 categories and 33 types for gallbladder ducts and 8 subtypes for gallbladder arteries,effectively preventing bile duct injuries and postoperative complications.(2)Malignant obstructive jaundice,especially when originating from high-level obstructions caused by hilar cholangiocarcinoma,has shown enhanced surgical success rates when employing 3D laparoscopy in conjunction with hepaticojejunostomy.For low-level obstructions,the implementation of tertiary prevention measures during pancreaticoduodenectomy demonstrates efficacy in the reduction of complications,such as pancreatic leakage.In cases where surgical resection is not feasible,palliative biliary drainage,either internal or external,can alleviate jaundice and preserve organ function.This article summarizes the experiences and outcomes of applying novel clinical techniques in the management of obstructive jaundice over the past two decades in our single-center institution.