Sotiropoulos Georgios C, Spartalis Eleftherios, Machairas Nikolaos, Kouraklis Gregory
2nd Department of Propaedeutic Surgery, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
2nd Department of Propaedeutic Surgery, 'Laikon' Hospital, University of Athens Medical School, Athens, Greece.
BMJ Case Rep. 2017 Jul 31;2017:bcr-2016-217368. doi: 10.1136/bcr-2016-217368.
The geographical distribution of Greece and the growing proportion of uninsured patients make imperative the need for effective and efficient palliative solutions regarding obstructive jaundice due to hepatic malignancy, while repeated endoscopic interventions and all associated materials are either not accessible to the whole population or not even available on a daily basis due to the economic crisis and the difficulties on the hospital supply. On this basis, palliative hepatojejunostomy, introduced more than 50 years ago, could be revisited in the Greek reality in very selected cases and under these special circumstances. We report on two patients with locally advanced hilar cholangiocarcinoma and intrahepatic cholangiocarcinoma, respectively, who were treated with a combination of double hepaticojejunostomy with peripheral hepatojejunostomy or peripheral hepatoejunostomy alone, respectively. Both patients experienced an adequate decompression of the biliary tract over more than a year. Palliative hepatojejunostomy could be an ultimate solution for selected patients and circumstances in Greece during the economic crisis.
希腊的地理分布以及未参保患者比例的不断增加，使得针对肝恶性肿瘤所致梗阻性黄疸采取有效且高效的姑息治疗方案成为当务之急。然而，由于经济危机以及医院供应困难，反复的内镜干预及所有相关材料并非全体民众都能获得，甚至无法每日供应。在此基础上，50多年前引入的姑息性肝空肠吻合术，在希腊的现实情况下，在经过严格筛选的病例中、在这些特殊情形下，或许值得重新审视。我们报告了两名分别患有局部晚期肝门胆管癌和肝内胆管癌的患者，他们分别接受了双侧肝空肠吻合术联合外周肝空肠吻合术或仅接受外周肝空肠吻合术的治疗。两名患者在一年多的时间里胆道均得到了充分减压。在经济危机期间，姑息性肝空肠吻合术对于希腊特定的患者和情况可能是一种终极解决方案。
