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目的 观察与评价肝内三级肝管空肠吻合术治疗恶性肝门部胆管梗阻的减黄效果 ,合并症及对生存期的影响。方法 切除部分肝左外侧叶 ,解剖出左外下段支肝管或切除右前叶下段部分肝组织 ,解剖出右前下段支肝管与空肠行Roux y吻合 ,在有效减黄率 ,合并症 ,黄疸再发率及生存期等方面与三组非外科胆管引流方法PTBD、ERBD、EMBE进行对照比较。结果 手术组与经皮经肝胆管引流术 (PTBD)、经内镜逆行性胆管引流术 (ERBD)、经皮经肝自膨式金属支架术 (EMBE)。有效减黄率 :分别是 95 %、89.8%、73 %、93 % ;早期合并症发生例数 :1例 /10例 ,8例 /3 5例 ,12例 /2 1例 ,1例 /10例 ;黄疸再发率 :0 % ,5 0 % ,40 % ,0 % ;平均生存期 (天 ) :2 46 ,117.3 ,198.40 ,2 0 3 .6 ,均P <0 .0 5。结论 肝内三级肝管空肠吻合术对于不能切除的恶性肝门部胆管梗阻是确实可行的治疗方法 ,其减黄效果优于PTBD、ERBD和EMBE。
Objective To observe and evaluate the effects of three intrahepatic hepaticojejunostomy on the reduction of yellowing, complications and survival in patients with malignant hilar bile duct obstruction. Methods The left lateral lobe of the liver was excised and the left hepatic duct was dissected or the part of the hepatic tissue in the lower right anterior lobe was excised. The Roux y of the right hepatic duct in the lower right anterior segment was anatomized. The effective rate of yellowing, complications and jaundice Hair loss and survival of three groups of non-surgical biliary drainage methods PTBD, ERBD, EMBE were compared. Results The operation group and percutaneous transhepatic biliary drainage (PTBD), endoscopic retrograde biliary drainage (ERBD), percutaneous transhepatic metal stent (EMBE). The effective reduction of yellowing rate was 95%, 89.8%, 73% and 93% respectively. The incidence of early complications was 1 case / 10 cases, 8 cases / 35 cases, 12 cases / 21 cases and 1 case / 10 cases Cases; jaundice recurrence rate: 0%, 50%, 40%, 0%; mean survival time (days): 2 46, 117.3, 198.40, 2 0 3 .6, all P <0. Conclusions Intrahepatic three-stage hepaticojejunostomy is a feasible and feasible treatment for unresectable malignant hilar cholangiocarcinoma. The anti-yellowing effect is better than that of PTBD, ERBD and EMBE.