腹腔镜胆肠'T'管架桥内引流术在晚期恶性梗阻性黄疸中的临床应用

摘要

目的:探讨腹腔镜胆肠"T"管架桥内引流术在晚期恶性梗阻性黄疸中的临床应用效果.方法:2004年11月至2008年9月收治不能切除的壶腹周围癌伴有梗阻性黄疸的患者9例,应用腹腔镜行胆道空肠间"T"管架桥完成减黄内引流术.结果:6例胆总管空肠"T"管架桥,2例肝总管空肠"T"管架桥,1例胆囊空肠"T"管架桥,手术均获成功,术后低流量胆漏1例,引流后痊愈.手术时间50～80min.术后约10d全身黄疸基本消退,痊愈出院.随访无反流性胆管炎发生,生存期7～19个月.结论:腹腔镜胆肠 "T"管架桥内引流术是治疗不能切除的壶腹周围癌伴梗阻性黄疸简便易行且创伤较小的姑息性减黄术式.%Objective:The aim of the present study was to investigate the clinical application effect of laparoscopie internal drainage by T-tube common bile duct-jejunum bridging in the late malignant obstructive jaundice. Methods: Nine patients who suffered from unresectable periampullary tumor and obstructive jaundice adopted laparoscopie T-tube common bile duct-jejunum bridging to relieve jaundice. Results: All operations were successful, including 6 cases of common bile duct-jejunum bridging ,2 cases of common hepatic duct-jejunum bridging and 1 case of gallbladder-jejunum bridging. One patient suffered from low flow rate bile leakage and was cured by drainage. The operative time was 50-80min. Jaundice of all the patients regressed 10 days after operation. No back-streaming cholangitis were found in follow-up. The life span was 7-19 months. Conclusions: Laparoscopic internal drainage by T-tube common bile duct-jejunum bridging is a relatively simple and minimally traumatic surgical procedure to palliatively reduce jaundice for unresectable periampullary carcinoma with obstructive jaundice.