半肝切除联合循环牵拉胆管缝合法在治疗高位胆管损伤中的应用

Application of hemihepatectomy combined with a circular-stretching suturing technique in bile duct anastomosis in the treatment of high level bile duct injuries

目的探讨半肝切除联合循环牵拉胆管缝合法在治疗高位胆管损伤中的应用效果。方法回顾分析2000年1月至2018年1月绵阳市中心医院采用半肝切除联合循环牵拉胆管缝合法治疗腹腔镜胆囊切除术(LC)所致高位胆管损伤的11例患者资料。所有患者均合并左右肝管汇合部的损伤,6例合并右肝动脉损伤,其中1例右肝动脉及门静脉右支同时损伤,5例合并右肝萎缩。LC到肝切除中位时间间隔17.0(2.0~61.0)个月。既往胆道修复次数1~4次,平均2次。胆管缝合采用循环牵拉法。结果围手术期无死亡患者,左半肝切除1例,右半肝切除10例。肝管空肠Roux-en-Y吻合9例,胆管端端吻合2例,手术时间(245.9±87.4)min,术中失血量(655.7±413.6)ml,术后中位住院时间12.0(7.0~29.0)d,5例患者出现并发症。中位随访时间47.0(15.0~89.0)个月,吻合口狭窄复发1例,胆管炎1例,其余9例患者恢复良好。结论经充分术前准备,有选择性地采用半肝切除联合循环牵拉胆管缝合法治疗高位胆管损伤能够取得满意的治疗效果。

Objective To study hemihepatectomy combined with a circular-stretching suturing technique in bile duct anastomosis in treatment of high level bile duct injuries(BDI).Methods From January 2000 to January 2018,eleven patients with high level BDI caused by laparoscopic cholecystectomy(LC)were treated in Mianyang Central Hospital with hemihepatectomy combined with a circular-stretching suturing technique in the bile duct anastomosis.The hilar confluence was involved in all these patients.A total of six patients had combined right hepatic artery injury with 1 having associated right portal vein injury.A total of five patients had developed right liver atrophy.The median time interval from LC to hepatectomy was 17.0(2.0~61.0)months.The number of previously attempted biliary repairs was 1~4 times(median 2 times).The bile duct anastomosis was performed by the circular-stretching suturing technique.Results There was no perioperative death.One patient underwent left hemihepatectomy and 10 patients right hemihepatectomy.Roux-en-Y hepaticojejunostomy was carried out in 9 patients,and bile duct end-to-end anastomosis in 2 patients.The operation time was(245.9±87.4)min,intraoperative blood loss(655.7±413.6)ml,and the median postoperative hospital stay 12.0(7.0~29.0)days.Five patients developed complications.The median follow-up was 47.0(15.0~89.0)months.One patient developed anastomotic stenosis and 1 patient had cholangitis.The remaining 9 patients were well.Conclusion After adequate preoperative preparation,patients who were treated with hemihepatectomy combined with the circular-stretching suturing technique for bile duct anastomosis to treat high level BDI achieved good results.