Launois B, Catheline J M, Maddern G J
Department of Digestive Surgery, Hôpital Pontchaillou, Rennes, France.
Arch Surg. 1995 Feb;130(2):137-42. doi: 10.1001/archsurg.1995.01430020027002.
To assess the role, techniques, and outcome of intrahepatic biliary anastomoses in patients undergoing resective or palliative surgery at the hepatic hilum.
A retrospective review over a 23-year period of all patients undergoing intrahepatic bilioenteric anastomoses.
A major university teaching hospital in France.
Over a 23-year period, 59 patients (19 with palliative, 35 with curative, and five with benign disease) underwent intrahepatic bilioenteric anastomoses.
There was a hospital mortality of six for the palliative group and four for the curative group. A significant fall in both the serum bilirubin and alkaline phosphate levels occurred after surgery (P < .5). Long-term follow-up was possible in 44 patients. Recurrent stenosis due to recurrent disease occurred in 100% of the palliative group and 69% of the curative group. There were two stenoses in four patients with benign disease. Recurrent cholangitis developed in 37 patients, five without apparent stenosis. The median survival for the palliative group was 6 months (range, 2 days to 13 months) and for the curative group, 21.7 months (range, 0.5 to 148 months); all the benign group remain alive.
Despite the advent of modern endoscopic and percutaneous intubation techniques, intrahepatic anastomoses after tumor resection offer the only chance of cure for obstructing hilar malignant disease.
评估肝内胆管吻合术在肝门部接受根治性或姑息性手术患者中的作用、技术及疗效。
对所有接受肝内胆管肠吻合术的患者进行为期23年的回顾性研究。
法国一所大型大学教学医院。
在23年期间，59例患者（19例姑息性手术、35例根治性手术、5例良性疾病）接受了肝内胆管肠吻合术。
姑息性手术组医院死亡率为6例，根治性手术组为4例。术后血清胆红素和碱性磷酸酶水平均显著下降（P < 0.5）。44例患者进行了长期随访。姑息性手术组100%因疾病复发出现复发性狭窄，根治性手术组为69%。5例良性疾病患者中有2例出现狭窄。37例患者发生复发性胆管炎，其中5例无明显狭窄。姑息性手术组中位生存期为6个月（范围：2天至13个月），根治性手术组为21.7个月（范围：0.5至148个月）；所有良性疾病组患者均存活。
尽管现代内镜和经皮插管技术不断涌现，但肿瘤切除术后的肝内吻合术仍是治疗肝门部恶性梗阻性疾病唯一的治愈机会。
