Chaudhary A, Dhar P, Tomey S, Sachdev A, Agarwal A
Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital, New Delhi, India.
World J Surg. 1997 Oct;21(8):866-70; discussion 870-1. doi: 10.1007/s002689900319.
Jaundice in patients of advanced carcinoma of the gallbladder requires palliation for the distressing symptoms of pruritus and cholangitis. Intrahepatic segment III duct cholangiojejunostomy is a means for alleviating the obstruction with malignant porta block. The authors reviewed their experience with this procedure in 48 patients of carcinoma of the gallbladder. All patients had jaundice; pruritus was present in 44 (92%) and cholangitis in 14 (29%). The level of obstruction was determined preoperatively by percutaneous transhepatic cholangiography. In 32 patients the block was below the level of the bifurcation of the right and left ducts, and 16 patients had a block involving the confluence, isolating the two lobes of the liver. Following segment III cholangiojejunostomy, pruritus was relieved in all and cholangitis in 86% of patients. At the end of 6 weeks a significant fall in serum bilirubin and alkaline phosphatase levels was seen with both types of hilar obstruction. Varying degrees of pain relief was also noted in 75% of patients. Segment III biliary bypass is an effective, one-time, reliable means of palliation for carcinoma of the gallbladder with hilar obstruction. Its efficacy appears to depend on the duration and depth of the jaundice and on the anatomy of the biliary ductal system in the left hemiliver rather than on the type of hilar obstruction.
晚期胆囊癌患者出现黄疸时，需要缓解瘙痒和胆管炎等令人痛苦的症状。肝内Ⅲ段胆管空肠吻合术是一种缓解恶性肝门部梗阻所致阻塞的方法。作者回顾了他们对48例胆囊癌患者实施该手术的经验。所有患者均有黄疸；44例（92%）有瘙痒，14例（29%）有胆管炎。术前通过经皮经肝胆管造影确定梗阻水平。32例患者的梗阻位于左右肝管分叉以下，16例患者的梗阻累及汇合部，使肝的两叶分离。Ⅲ段胆管空肠吻合术后，所有患者的瘙痒症状均得到缓解，86%的患者胆管炎得到缓解。6周结束时，两种类型的肝门部梗阻患者的血清胆红素和碱性磷酸酶水平均显著下降。75%的患者还出现了不同程度的疼痛缓解。Ⅲ段胆管旁路术是一种有效、一次性、可靠的缓解肝门部梗阻性胆囊癌的姑息治疗方法。其疗效似乎取决于黄疸的持续时间和深度以及左半肝胆管系统的解剖结构，而非肝门部梗阻的类型。
