肝圆韧带修复肝门部胆管治疗右肝动脉骑跨引起的胆管狭窄

Ligamentum Teres Hepatis for Reconstruction of Stenotic Hilar Bile Duct Caused by Overriding of the Right Hepatic Artery

目的探讨带蒂肝圆韧带修复右肝动脉骑跨引起的肝门部胆管狭窄的效果。方法回顾性分析2007年1月～2011年2月利用带蒂肝圆韧带修复右肝动脉骑跨引起的肝门部胆管狭窄5例的临床资料。胆管狭窄处直径1.5～3 mm。5例均采用离断右肝动脉,游离带蒂肝圆韧带,将肝圆韧带覆盖于胆管缺损处,自上而下,以3-0血管缝合线间断全层缝合胆管切缘与肝圆韧带,重建胆管前壁,放置T管引流的方法。结果 5例手术均获成功,手术时间90～170 min,平均120 min。肠蠕动3～4 d恢复。无围手术期死亡。T管放置3～6个月,平均4.3月。5例随访8～26个月,平均18.8月,未发生腹痛、黄疸、发热等胆管狭窄、胆管炎症状。结论利用带蒂肝圆韧带修复右肝动脉骑跨引起的肝门部胆管狭窄,能有效地避免胆管再狭窄、逆行性胆道感染等手术并发症的发生。

Objective To evaluate the efficacy of reconstruction with pedicled ligamentum teres hepatis for stenotic hilar bile duct caused by overriding of the right hepatic artery. Methods The clinical data of five patients with overriding of the right hepatic artery, which caused stenosis of the hilar bile duct, were retrospectively analyzed. The patients received reconstruction of the hilar bile duct with the pedicled ligamentum teres hepatis in our hospital from January 2007 to February 2011. The diameter of the stenotic bile duct ranged from 1.5 to 3 ram. In all the cases, we cut the right liver artery and separated the ligamentum teres hepatis, with which, the defective bile duct was repaired. With a 3-0 suture, we performed interrupted full-thickness suture of the bile duct cutting edge and ligamentum teres hepatis to reconstruct the anterior wall of the bile duct. T-tube drainage was used after the procedure. Results The procedure was completed successfully in all the 5 cases within a mean of 120 min （ rang,90 - 170）. The recovery time of intestinal peristalsis ranged from 3 to 4 days after the operation. No peri-operative death occurred. The T-tube was withdrawn in 3 to 6 months （mean, 4.3）, and the patients were followed up for 8 to 26 months （mean, 18. 8）. During the follow-up, no patient showed abdominal pain, jaundice, fever, or other symptoms of stenosis of the bile duct or cholangitis. Conclusion For patients with stenotic hilar bile duct caused by overriding of the right hepatic artery, bile duct reconstruction with the ligamentum teres hepatis is effective in avoiding re-stenosis of the bile duct and retrograde bile duct infection.