胆-肠T管架桥内引流治疗梗阻性黄疸130例.DOCVIP

临床医学论文-胆-肠T管架桥内引流治疗梗阻性黄疸130例 【摘要】? 目的 评估胆-肠T管架桥内引流术治疗恶性梗阻性黄疸的效果。方法 回顾分析130例恶性梗阻性黄疸的临床资料；男83例，女47例，年龄53～82岁，胰头癌114例，胆囊癌浸润胆管10例，胆管癌6例，随访2年。结果 全组患者均顺利恢复，术后1周血清总胆红素水平降低50%；除有严重肝转移者外，绝大多数病人于术后1～2个月恢复正常。结论 本术未见并发症，但可迅速消退黄疸，改善患者生活质量，是一种简便有效的姑息性手术；是不能切除癌肿和不能耐受大手术的恶性梗阻性黄疸患者的最佳选择。 【关键词】? T管架桥；内引流；梗阻性黄疸 ????? Biliary-jejunal internal drainage bridging by T tube for malignant obstructive jaundice ??? ［Abstract］? Objective? To evaluate the effect of biliary-jejunal internal drainage bridging by T tube for malignant obstructive jaundice.Methods? Through a retrospectively analysis of? the clinical data of 130 cases，which included 47 women and 83 men，ageing from 53 to 82 years.One hundred and fourteen patients with carcinoma of the head of pancreas and 10 gallbladder cancer involve the bile duct and 6 cholangiocarcinoma had been followed up for 1～2 years.Results? All postoperative patients recovered smoothly.Serum bilirubin in all cases reduced 50% in one postoperative week and the bilirubin of most patients were normal within 1～2 months postoperatively unless who had severe liver metastasis.Conclusion? This operation can reduce jaundice rapidly and can improve the quality of life of patients without any complication.This is a excellent palliative operation and is a good choice for irresectable tumor with obstructive jaundice and poor operative tolerant patients. ??? ［Key words］? bridging by T tube；internal drainage；obstructive jaundice ??? 胰头癌和肝外胆管癌起病隐匿而发展迅速，因其早期仅有模糊的上腹不适，无更多明显的症状；故早期诊断较为困难。当有梗阻性黄疸出现时，病情进入中、晚期，并浸润血管，多已不能根治切除。笔者创建一种简单易行的胆-肠T管架桥内引流术，可迅速消退黄疸、改善病人生活质量、创造非手术治疗条件，延长病人生命。现将其报告如下。 ??? 1? 临床资料 ??? 1.1? 一般资料? 1978年3月～2004年3月收治130例，男83例，女47例。年龄53～82岁，平均67.5岁。胰头癌114例，胆囊癌侵犯胆管10例，胆管癌6例。其中21例伴肝转移。术前血清胆红素水平306～425 μmol/L。 ??? 1.2? 手术指征? 其手术指征有：（1）不能切除的和（或）伴有肝转移而不能根治的胰头癌和肝外胆管癌；（2）高龄患者或被认为不能耐受切除的患者。 ??? 1.3? 手术操作? 右上腹直肌切口进腹探查，术者在不能切除肿瘤的上方或肝门区找到扩张的胆管后，切开胆管并置入F22 T形管引流；将T管的另一端经横结肠系膜无血管区戳洞伸向中腹腔。在T管端剪成鱼口状后再剪一个侧孔，然后将其置入距Treitz韧带30～40 cm处的空肠腔内。沿T管周围的空肠壁上作两道荷包缝线并收紧后；再将T管周围的空肠壁和横结肠系膜作6～8针