Abdominal Surgery Department, Hospital do Cancer AC Camargo, Rua Professor Antonio Prudente 211, Liberdade, Sao Paulo, Brazil.
Hepatobiliary Pancreat Dis Int. 2010 Dec;9(6):654-7.
Obstructive jaundice is a common condition in advanced digestive cancer. Palliative procedures can improve quality of life and allow patients to attempt a systemic treatment. Bilioenteric anastomosis is still the procedure of choice for patients in many centers. When a surgical bypass is not possible, biliary drainage can be done by placing endoscopic or transparietal stents, which are less durable methods even when an expandable stent is employed.
A 47-year-old male with an excellent clinical status and a previous cholecystectomy and an exploratory laparotomy for advanced gastric cancer was referred with obstructive jaundice. A preoperative CT scan showed a dilated bile duct and a small mass at the distal hepatic hilum. No other signs of metastasis were found. A surgical bilioenteric anastomosis was indicated. At surgery, a distal choledochal obstruction and a mesenteric retraction by a lymph node mass prevented the jejunum to ascend for a bilioenteric anastomosis. Surgically, an alternative bilioenteric bypass was performed by means of an ileal loop interposition between the bile duct and the jejunum.
The recovery of the patient was uneventful and his bilirubin levels normalized after one week. The patient was then referred for systemic chemotherapy.
This alternative biliary bypass can be safely and easily performed, and may be a good alternative for patients already referred for surgery because of a better life expectancy and when the jejunum is not an alternative.
阻塞性黄疸是晚期消化道癌症的常见病症。姑息性手术可以提高生活质量，并使患者能够尝试全身治疗。在许多中心，胆肠吻合术仍然是首选的手术方法。当无法进行手术旁路时，可以通过放置内镜或经皮支架进行胆管引流，但即使使用可扩张支架，这些方法的耐用性也较差。
一名 47 岁男性，临床状况良好，曾因晚期胃癌行胆囊切除术和剖腹探查术，因阻塞性黄疸就诊。术前 CT 扫描显示胆管扩张，肝门远端有一小肿块。未发现其他转移迹象。术前计划行胆肠吻合术。手术中，由于胆总管远端阻塞和肠系膜回缩，导致空肠无法上升进行胆肠吻合。手术中，通过在胆管和空肠之间插入回肠袢来进行替代胆肠旁路。
患者的恢复过程顺利，一周后胆红素水平恢复正常。随后，患者被转介进行全身化疗。
这种替代胆肠旁路可以安全且轻松地进行，对于因预期寿命较长且空肠无法替代而已经被转介手术的患者来说是一种较好的选择。
