Karamarković A, Milić N, Djukić V, Radenković D, Jeremić V, Bumbasirević V, Popović N, Kojić Z, Bajec Dj
Centar za Urgentnu Hirurgiju KCS, Beograd.
Acta Chir Iugosl. 2004;51(3):85-91. doi: 10.2298/aci0403085k.
Palliating the effects of biliary obstruction is a major goal of therapy in patients with unresectable cancer at the hepatic duct confluence. We reviewed our expirience with intrahepatic holangioenteric bypass to the segmental bile duct B3 as a palliative therapy in patients with unresectable malignant diseases involving the ductal confluence or the common hepatic duct. Since March 2001, we have performed intrahepatic segmental bile duct B3 cholangiojejunostomy by Roux-en-Y fashion utilizing a round ligament approach in 13 patients with malignant obstructive jaundice due to unresectable hilar holangiocarcinoma (8 cases) and gallbladder cancer (5 cases). Mean hospital stay was 123 days and mean blood loss was 25060 mL. Postoperative complications occurred in 3 patients (23%), but there was no surgical complications such as postoperative bleeding, bile leakage or abscess formation. 30-day mortality was 7.7% (1 patient). Late complications (37.5%) were observed in 3 of the 8 patients who survived for more than 5 months after the surgery. Median survival after B3 cholangiojejunostomy was 9 months (range, 10 days-22 months). Median survival time was significantly greater in patients with hilar cholangio-carcinoma (11.8 months; range: 2-22 months) compared with those with gallbladder cancer (4.6 months; range: 10 days-11.5 months) (P-0.032 log rank test; P-0.049 Tarone-Ware test). Intrahepatic B3 cholangiojejunostomy when combined with careful patient selection, can provide useful palliation from jaundice, pruritus and cholangitis with acceptable mortality and morbidity rates.
缓解胆管梗阻的影响是肝管汇合处不可切除癌症患者治疗的主要目标。我们回顾了我们将肝内胆管空肠吻合术应用于肝段胆管B3作为姑息治疗涉及胆管汇合处或肝总管的不可切除恶性疾病患者的经验。自2001年3月以来，我们采用圆韧带入路，以Roux-en-Y方式对13例因不可切除的肝门部胆管癌（8例）和胆囊癌（5例）导致恶性梗阻性黄疸的患者进行了肝内肝段胆管B3胆管空肠吻合术。平均住院时间为123天，平均失血量为25060毫升。3例患者（23%）发生术后并发症，但未出现术后出血、胆漏或脓肿形成等手术并发症。30天死亡率为7.7%（1例患者）。在手术后存活超过5个月的8例患者中，有3例观察到晚期并发症（37.5%）。B3胆管空肠吻合术后的中位生存期为9个月（范围：10天至22个月）。与胆囊癌患者（4.6个月；范围：10天至11.5个月）相比，肝门部胆管癌患者的中位生存时间显著更长（11.8个月；范围：2至22个月）（对数秩检验P = 0.032；Tarone-Ware检验P = 0.049）。肝内B3胆管空肠吻合术结合仔细的患者选择，可以在可接受的死亡率和发病率的情况下，有效缓解黄疸、瘙痒和胆管炎。
