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KMID : 0378019810240060101
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New Medical Journal
1981 Volume.24 No. 6 p.101 ~ p.106
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Surgical Procedures for Malignant Intrahepatic Biliary Obstruction
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Abstract
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A case of unresectable biliary cancer due to frozen hepatic hilum or wide spread of it, palliative biliary bypass procedures were applicated for decompression of bile, because common cause of death in such patient is mostly due to hepatic failure or septic cholangitis secondary to the obstruction of bile flow than spread of cancer perse.
Since Longmire developed a palliative method of bile drainage with anastomosis of peripheral left hepatic duct to small intestine, numerous procedures of bile diversion were introduced in biliary surgery.
As far as palliative biliary drainage concerned, two surgical principles should be established for succesful drainage. The one is drainage of bile anatomically from both hepatic lobe of left and right hepatic duct and the other drainage physiologically into duodenum or small intestine for good maintenance of bilous digestive action.
The internal drainage with various fashion of anastomosis between biliary tract and small intestine, therefore, is preferred than external with discard of out-drained bile. But in cases of frozen hepatic hilum and exploration of proximal part of hepatic duct is not possible, external drainage is inevitable.
Recently in cases of the palliative surgery of biliary tract cancer, authors started to establish two surgical principles with both hepatic duct drainage and reestablishment of bile flow to small intestine as far as possible and had good palliative results.
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