Confalonieri F, Ballerini A
Azienda USSL Ambito Territoriale N. 31, Presidio Ospedaliero Città di Sesto San Giovanni, Milano.
Minerva Chir. 1998 Sep;53(9):709-14.
Aim of the paper is to prove that indications for cholangiojejunostomy, in cases when a mean and long term palliation may be expected, are better than those offered by the use of prostheses, without the well known and early bile duct complications.
Between 1984 and 1995, 12 patients with obstructive jaundice due to malignancy at the hepatic hilum were treated by segment III Roux-en-y or omega cholangiojejunostomy. In 1 patient with no communication between right and left lobe of the liver, biliary-enteric bypass to segment VI duct was also undertaken; in another with neoplastic stenosis of pylorus gastrojejunostomy was performed. Seven patients had carcinoma of the gallbladder, three hilar cholangiocarcinoma, one gastric carcinoma and one recurrent pancreatic carcinoma.
There were two postoperative deaths, one for myocardial infarction and one for biliary peritonitis. Six patients had complications: four biliary fistulas with spontaneous resolution and two wound infections. Seven of the ten surviving patients experienced complete resolution of jaundice for at least 4 months. The mean survival of surviving patients was 9.7 months. Nine patients developed recurrent jaundice.
Segment III cholangiojejunostomy is a good palliative treatment in most patients with malignant hilar obstruction.
本文旨在证明，在预期可实现中期和长期姑息治疗的情况下，胆管空肠吻合术的适应证优于使用假体，且无众所周知的早期胆管并发症。
1984年至1995年间，12例肝门部恶性肿瘤导致梗阻性黄疸的患者接受了Ⅲ段Roux-en-y或Ω形胆管空肠吻合术治疗。1例肝左右叶无交通的患者还进行了与Ⅵ段胆管的胆肠旁路手术；另1例幽门肿瘤性狭窄患者进行了胃空肠吻合术。7例为胆囊癌，3例为肝门胆管癌，1例为胃癌，1例为复发性胰腺癌。
术后有2例死亡，1例死于心肌梗死，1例死于胆汁性腹膜炎。6例出现并发症：4例胆瘘自行愈合，2例伤口感染。10例存活患者中有7例黄疸完全消退至少4个月。存活患者的平均生存期为9.7个月。9例患者出现复发性黄疸。
Ⅲ段胆管空肠吻合术是大多数恶性肝门梗阻患者的一种良好姑息治疗方法。
