Burlui D, Brătucu E, Bobocescu E, Dragoncea C
Rev Chir Oncol Radiol O R L Oftalmol Stomatol Chir. 1981 May-Jun;30(3):191-8.
In the paper are presented a total of 9 patients with primitive sclerous cholangitis that were hospitalized in the Surgical Department of the "Caritas" Hospital with this rare nosologic entity. The etiology of the disease is neither precise nor incontroversial. Primitive sclerous cholangitis raises particularly difficult problems, because of the high mortality rate (all patients die before the 6-th year after the diagnosis has been established. The ineluctable evolution of the disease toward secondary billiary cirrhosis has generated major difficulties in the choice of the treatment. Corticoid therapy and immunosuppressive drugs have been proven inefficient in improving the prognosis. The classical surgical therapy includes methods that are not followed by stable results since the icteric syndrome will show temporary remission, in spite of the fact that the chronic hepatopathy will continue its independent evolution. The authors have not achieved satisfactory results with the classical surgical techniques, which include external biliary draining and peri-hepatic artery neurectomia (either isolated or combined), not with the internal derivations. Since 1971 the authors have used oddian sphincterectomy in the treatment of sclerous cholangitis. The method was introduced following a long clinical and histopathologic study. The immediate and the late results obtained with this technique recommend it as a choice one because it will lead to disappearence of the jaundice and to stabilization of the hepatic lesions.
本文介绍了9例原发性硬化性胆管炎患者，他们因这种罕见的疾病实体在“慈善”医院外科住院。该疾病的病因既不确切也无定论。原发性硬化性胆管炎引发了特别棘手的问题，因为死亡率很高（所有患者在确诊后第6年之前死亡）。疾病不可避免地向继发性胆汁性肝硬化发展，这给治疗选择带来了重大困难。皮质类固醇疗法和免疫抑制药物已被证明在改善预后方面无效。经典的外科治疗方法包括一些无法取得稳定效果的术式，因为黄疸综合征会出现暂时缓解，尽管慢性肝病会继续独立发展。作者采用经典外科技术（包括外部胆管引流和肝周动脉神经切除术，单独或联合使用）以及内部引流术均未取得满意效果。自1971年以来，作者一直使用Oddi括约肌切除术治疗硬化性胆管炎。该方法是在长期的临床和组织病理学研究之后引入的。用这种技术获得的近期和远期效果使其成为首选方法，因为它能使黄疸消退并使肝脏病变稳定。
