Kapoor V K, Pradeep R, Haribhakti S P, Singh V, Sikora S S, Saxena R, Kaushik S P
Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Br J Surg. 1996 Dec;83(12):1709-11. doi: 10.1002/bjs.1800831215.
The majority of patients with advanced carcinoma of the gallbladder have irresectable disease and require palliation for jaundice, pruritus and cholangitis. Intrahepatic segment III cholangiojejunostomy has been described for palliation of high biliary obstruction in these patients. Forty-one patients with stage IV gallbladder cancer underwent intrahepatic segment III cholangiojejunostomy. Subsequent jaundice, pruritus and cholangitis were documented; liver function tests and isotope hepatobiliary scans were performed. All patients had jaundice, 29 had pruritus and 12 had cholangitis. Postoperative complications included anastomotic leak in six patients and wound infection in six. Five patients died within 30 days of operation. Thirty-two patients were available for follow-up. The procedure failed to relieve jaundice, pruritus or cholangitis in four patients; 18 were free of jaundice, pruritus and cholangitis until death or last follow-up, and ten had recurrent jaundice or cholangitis. Isotope scanning was found to be useful to predict success of the procedure. Intrahepatic segment III cholangiojejunostomy provided excellent palliation from jaundice, pruritus and cholangitis with acceptable mortality and morbidity rates in patients with advanced carcinoma of the gallbladder.
大多数晚期胆囊癌患者患有无法切除的疾病，需要针对黄疸、瘙痒和胆管炎进行姑息治疗。肝内Ⅲ段胆管空肠吻合术已被描述用于这些患者高位胆道梗阻的姑息治疗。41例Ⅳ期胆囊癌患者接受了肝内Ⅲ段胆管空肠吻合术。记录了随后出现的黄疸、瘙痒和胆管炎情况；进行了肝功能检查和同位素肝胆扫描。所有患者均有黄疸，29例有瘙痒，12例有胆管炎。术后并发症包括6例吻合口漏和6例伤口感染。5例患者在术后30天内死亡。32例患者可供随访。该手术未能缓解4例患者的黄疸、瘙痒或胆管炎；18例患者直至死亡或最后一次随访时均无黄疸、瘙痒和胆管炎，10例患者出现复发性黄疸或胆管炎。发现同位素扫描有助于预测该手术的成功率。肝内Ⅲ段胆管空肠吻合术为晚期胆囊癌患者的黄疸、瘙痒和胆管炎提供了良好的姑息治疗效果，且死亡率和发病率可接受。
