STUDIES ON INTRAHEPATIC-CHOLANGIOJEJUNOSTOMY

摘要

Ideal reconstruction of the bile-duct is to cut off the obstruction of the bile-duct and to continue the function of Oddi's sphincter. However, there are many cases in which reconstruction is impossible due to the location of the focus or anatomical properties. Therefore, in many cases re-routing of the flowing of bile must be done by cholecyst-gastroenterostomy or choledochogastroenterostomy. However, in cases in which the obstruction is at the bile-duct, especially near hepatic port, this is often impossible, for, not to mention cases caused by malignant tumor, in cases of error of operation of the bile-duct or benign obstruction based on inflammation, reconstruction of the bile-duct using the extrahepatic bile-duct could damage the portal vein or hepatic artery on account of strong adhesion or ciatrization. In these cases, it is possible to direct bile congested in the liver to the digestive tract, only by the route of the intrahepatic bile-duct. Therefore, anastomosis of the intrahepatic bileduct and the digestive tract is considered as the final reconstruction. This procedure of operation may be divided broadly into these classes: intrahepatic-cholangiogastrostomy performed by Longmire and Sanford, intrahepatic-cholangiogastrostomy performed by Dogliotti, hepatoenterostomy performed by Kehr, Honjo and Hasegawa. However, they cannot be said to be the general methods of operation at present as many of them have not succeeded. This paper reports twelve cases of intrahepatic-cholangiojejunostomy which the authors recently treated and descrives the outline of animal experimental data concerning this problem.