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目的:探索肝门部胆管癌高位切除并回盲部间置-肝门回肠吻合术的临床应用。方法:对2例肝门部胆管癌患者进行详细的术前评估和充分的术前准备,行肝门部胆管癌高位切除并回盲部间置-肝门回肠吻合术,术后给予预防感染、营养支持等治疗,随访3个月,总结临床资料。结果:2例患者术后病理证实为肝门部胆管癌BismuthⅣ型,术中均未输血,术后胆管支架管造影示回肠肠袢及肝内无明显气体。钡餐透视提示钡剂进入盲肠,未反流入回肠袢;口服钡剂后9 h透视提示盲肠肠袢和吻合部位空肠内钡剂排出,盲肠袋黏膜皱襞有少量钡剂残留,钡剂通过回肠-结肠吻合口时无延迟及明显过快,无明显钡剂反流。2例患者随访3个月,无反流性胆管炎发生。结论:肝门部胆管癌行高位切除、回盲部间置、肝门回肠吻合术是可行的。
Objective: To explore the clinical application of hilar resection of hilar cholangiocarcinoma and ileocecal home- hepatic ileostomy. Methods: Detailed preoperative assessment and adequate preoperative preparation were performed on 2 patients with hilar cholangiocarcinoma. High-level hilar cholangiocarcinoma was removed and ileocecal-hepatic ileostomy was performed. Postoperative infection prevention was given. Treatments such as nutrition support were followed up for 3 months and clinical data were summarized. RESULTS: The pathological findings of the 2 patients were confirmed as Bismuth IV of hilar cholangiocarcinoma. No blood transfusion was performed during the operation. Biliary stent angiography showed no gas in the ileum fistula and liver. Barium meal perspective prompt tincture into the cecum, not back into the ileum; 9h after oral tincture shows cecal bowel fistula and anastomosis site jejunum barium discharge, cecal bag mucosal folds with a small amount of tincture residue, tincture through the ileum - colon There was no delay in the anastomosis and it was obviously too fast and there was no obvious reflux of the expectorant. Two patients were followed up for 3 months and no reflux cholangitis occurred. Conclusions: Hilar resection of hilar cholangiocarcinoma, ileocecal placement, and hepatic ileostomy are feasible.