恶性梗阻性黄疸病人经圆韧带途径肝内胆管空肠吻合术

Intrahepatic cholangiojejunostomy through round ligament approach in the management of malignant obstructive jaundice

目的 评价经圆韧带途径行Ⅲ段胆管空肠吻合术姑息性治疗不能切除的恶性梗阻性黄疸病人的临床效果。方法 对 1999年 1月至 2 0 0 2年 12月间 5例不能切除的肝门部恶性梗阻性黄疸病人实施经圆韧带途径显露Ⅲ段肝内胆管 ,并与空肠行Roux en Y式吻合术。对术后血清胆红素和碱性磷酸酶进行动态检测 ,并就病人住院时间、术后生活质量、生存时间进行观察。结果 5例病人实施肝内胆管空肠吻合术后血清胆红素逐渐降低至正常范围 ,2例病人临终前可维持无黄疸状态。术后 1例并发胆漏 ,1例住院期间因胃肠道恶性梗阻恶病质死亡 ,其他病人均存活超过 13个月 ,最长达 2 3个月。本组 5例术后均无胆管炎和复发性胆道梗阻。结论 经圆韧带途径肝内胆管空肠吻合术是恶性梗阻性黄疸病人姑息治疗的有效术式 ,损伤小 ,方法简便 ,减黄效果确切 。

Objective To evaluate the effects of segment Ⅲ cholangiojejunostomy through round ligament approach for the palliative treatment of unresectable malignant obstructive jaundice.Methods Segment Ⅲ cholangiojejunostomy was performed in 5 patients with the malignant obstruction at the hilus of the liver from Jan. 1999 to Dec. 2002. The postoperative levels of the serum bilirubin and alkaline phosphatase were dynamically assayed and the duration of the hospital stay, postoperative survival time and life quality were also assessed. The serum bilirubin value was dropped gradually to normal level in 5 patients undergoing the intrahepatic cholangiojejunostomy, and 2 of them remained no jaundice before they died. Postoperative biliary leak was complicated in one patient and another patient died of the gastrointestinal obstructive metastases during the hospital stay. All of the other patients survived over 13 months and the longest one was up to 23 months. No postoperative cholangitis and recurrent biliary obstruction occurred in all patients.Conclusion Intrahepatic cholangiojejunostomy through round ligament approach was an effective operation for the palliative treatment of the malignant obstructive jaundice with less lesions, simpler procedure, more definite effects of decreasing jaundice as well as a better life quality.