肝门腹侧肝脏切除治疗复杂医源性高位胆道损伤

Role of quadrate lobe hepatectomy in the management of complex iatrogenic high biliary tract injury

目的探讨肝门腹侧肝脏切除手术处理复杂医源性高位胆管损伤的可行性和疗效。方法回顾性分析2013年3月至2020年5月湖南省人民医院肝胆外科采用肝门腹侧肝脏切除手术治疗的8例复杂医源性高位胆管损伤患者的临床资料。结果 8例患者中行ⅣB段部分切除5例,ⅣB段+Ⅴ段部分切除3例。患者均顺利完成手术,无住院死亡,1例出现膈下感染、腹腔积液,经积极抗感染治疗和腹腔穿刺引流后治愈。术后随访时间5~90个月,所有患者疗效评估均为优。术后胆管造影及MRI复查未见肝内胆管狭窄。结论肝门腹侧肝脏切除可充分显露一、二级胆管,有效处理复杂的医源性高位胆管损伤,建立通畅的胆肠引流通路。

Objective To evaluate partial ventral hepatectomy in the treatment of patients with complicated iatrogenic high bile duct injury.Methods The clinical data of 8 cases of complicated iatrogenic high bile duct injury treated with the assistance of hepatic ventral segmentectomy from Mar 2013 to May 2020 at Hunan Provincial People's Hospital was retrospectively analyzed.Results Among the 8 patients,5 patients underwent partialⅣb lobectomy,and 3 patients received partialⅣb andⅤsegmentectomy of the liver.All the operation was successful without death in hospital.One case developed subphrenic infection and seroperitoneum,which was healed by anti-infection treatment and abdominocentesis.The postoperative follow-up time was 5-90 months,and all of patients are doing well.There was no stenosis in intrahepatic bile duct by postoperative cholangiography or MRI.Conclusions Quadrate lobe hepatectomy provides a wide view for the treatment of complicated iatrogenic high bile duct injury by fully opening the first porta hepatis and exposing the primary and secondary bile duct branch helping establish a wide patent tension free bile duct-jejunostomy.