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[良性梗阻性黄疸的外科治疗策略]

[Surgical strategy in the management of benign obstructive jaundice].

作者信息

Hotineanu V, Ferdohleb A, Hotineanu A

机构信息

Clinica 1, Catedra 2 Chirurgie, Universitatea de Stat de Medicină şi Farmacie N.Testemitanu, Chişinau, Republica Moldova.

出版信息

Chirurgia (Bucur). 2005 May-Jun;100(3):241-50.

Abstract

623 patients with benign biliary obstructions of extrahepatic biliary ducts were treated in surgical clinic number 2 during the period of 1990-2002 years. Surgical treatment included 3 stages: (1) diagnosis of benign biliary obstructions; (2) preoperative biliary tree decompression; (3) definitive surgical resolve. Definitive diagnosis was established in 90% of cases after cholangiopancreatography retrograde endoscopic (CPGRE), in 7% of cases was used cholangiography transhepatic percutaneous with using ultrasonography, which was the method of choice in cases with high obstructions, and with gastric resections in anamnesis. In 22 cases with negative results of applied methods was used MRI of biliary tract, with permitted positive solution of problem. Surgical tactics was in direct dependency from pathology, level of obstruction, grade of clinical manifestation of the disease. In all cases was applied staged treatment, with permitted in pre-operative period to resolve the jaundice, biliary infection and correction of hepatic function with following surgical definitive correction with minimal risk of postoperative complications. The total lethality was 9 (1.44 %) patients.

摘要

1990年至2002年期间,第2外科诊所对623例肝外胆管良性梗阻患者进行了治疗。手术治疗包括三个阶段:(1)良性胆管梗阻的诊断;(2)术前胆管减压;(3)确定性手术解决。90%的病例在逆行内镜胰胆管造影(CPGRE)后确诊,7%的病例采用经皮肝穿刺胆管造影并结合超声检查,这是高位梗阻病例以及有胃切除术病史病例的首选方法。在22例应用方法结果为阴性的病例中,采用了胆道MRI检查,从而使问题得到了肯定性解决。手术策略直接取决于病理、梗阻水平、疾病临床表现分级。所有病例均采用分期治疗,在术前阶段允许解决黄疸、胆道感染并纠正肝功能,随后进行手术确定性纠正,使术后并发症风险降至最低。总死亡人数为9例(1.44%)。

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