Chirurgische Therapie entzündlicher und maligner Stenosen der distalen Gallenwege

Zusammenfassung

Bei der Behandlung einer malignen oder benignen Stenose des distalen Gallengangs ist trotz gewachsener interventioneller Möglichkeiten die definitive operative Ableitung mittels terminolateraler Hepatikojejunostomie in vielen Fällen die Therapie der Wahl. Durch die modifizierte duodenumerhaltende Pankreaskopfresektion nach Beger wird bei distaler Choledochusstenose infolge chronischer Pankreatitis die Option der Gallengangsableitung mit einer organsparenden Resektion des Pankreaskopfes verknüpft. Von 391 Patienten aus dem eigenen Krankengut, die wegen distaler Gallengangsstenose operiert wurden, erhielten 337 Patienten eine Gallengangsableitung im Rahmen einer Pankreaskopfresektion. Frühpostoperative biliäre Komplikationen waren mit 0,3 % Strikturen und 1,5 % Gallefisteln selten und wurden in der Hälfte erfolgreich konservativ behandelt. In Zentren stellt die operative Therapie von distalen Gallengangsstenosen ein risikoarmes Verfahren mit hoher Erfolgsrate dar.

Abstract

Although there are growing possibilities of interventional endoscopic treatment of benign and malignant stenosis of the distal common bile duct the definitive operative drainage by terminolateral hepaticojejunostomy is in many cases the therapy of choice. In patients with chronic pancreatitis and bile duct stricture the modified duodenum preserving pancreatic head resection (“Beger operation”) enables a resection of the inflammatory mass together with a drainage of the bile. Of 391 patients from our clinic being operated due to a bile duct stricture 337 underwent a biliary drainage together with a pancreatic head resection. Early postoperative biliary complications were in 0.3 % strictures of the duct and 1.5 % bile fistulas. Half of those complications could be managed conservatively. In high volume centers the operative therapy of distal common bile duct stenosis is a safe procedure with high patency rate.

Schlüsselwörter

Biliäre Stenose - Hepatikojejunostomie - biliodigestive Anastomose - chronische Pankreatitis - Pankreaskopfresektion

Key words

Biliary stricture - hepaticojejunostomy - bilioenteric anastomosis - chronic pancreatitis pancreatic - head resection

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