肝圆韧带浆膜面在胆道修补中的应用

Application of the serosal surface of the round ligament of the liver in biliary repair

背景与目的:肝胆外科手术中可因各种原因发生胆管损伤、胆管缺损,如缺损较小可以直接行缝合修补,如缺损较大则往往需要行胆管对端吻合或胆肠Y吻合,后两种手术方式比较复杂,而且胆管对端吻合有可能由于吻合口的张力及血供问题出现胆汁漏、胆管狭窄,而胆肠吻合则改变了正常生理通道,并发症也较多,因此有必要寻求更为安全、有效、简便的胆管修补方法。本研究探讨肝圆韧带浆膜面修补胆管缺损的临床效果及其应用价值。方法:回顾性分析2008年5月-2023年3月6家医院13例采用肝圆韧带浆膜面修补胆管缺损患者的临床资料。结果:13例患者中男性3例,女性10例;年龄40~68岁,平均55.6岁;胆囊结石2例、胃癌1例、胆管炎性狭窄4例、肝左内叶肝细胞癌2例、其他恶性肿瘤4例。术后有6例(46.2%)患者发生胆汁漏,经胆管引流及腹腔引流5例患者于术后7~27 d停止,1例患者于术后56 d停止,无围手术期死亡。7例患者行胆管造影检查,未见胆汁漏、胆管狭窄及胆管结石征象。2例患者行胆管镜检查,未见胆管黏膜与肝圆韧带浆膜之间存在分界。术后随访时间3个月至14年,1例患者出现左侧肝内胆管轻度扩张,考虑肝圆韧带修补的左肝管可能存在狭窄,其余12例患者修补处胆管无狭窄及囊状扩张。结论:肝圆韧带浆膜面修补胆管缺损疗效好,且简单易行,值得临床推广应用。

Background and Aims:Bile duct injuries and defects can occur during hepatobiliary surgery due to various reasons.Minor defects can be repaired by direct suturing,while more significant defects often require end-to-end bile duct anastomosis or Roux-en-Y cholangiojejunostomy.These latter procedures are more complex and end-to-end anastomosis may lead to bile leakage or bile duct stricture due to tension at the anastomotic site and issues with blood supply.Cholangiojejunostomy alters the normal physiological pathway and is associated with more complications.Therefore,seeking a safer,more effective,and simpler method for bile duct repair is necessary.This study was performed to investigate the clinical efficacy and application value of using the serosal surface of the round ligament of the liver to repair bile duct defects.Methods:The clinical data of 13 patients who underwent bile duct defect repair using the serosal surface of the round ligament of the liver in 6 hospitals between May 2008 and March 2023 were retrospectively analyzed.Results:Among the 13 patients,3 were males and 10 were females,with ages ranging from 40 to 68 years(mean age 55.6 years).The underlying conditions included gallstones in 2 cases,gastric cancer in 1 case,inflammatory bile duct stricture in 4 cases,hepatocellular carcinoma in the left inner lobe of the liver in 2 cases,and other malignancies in 4 cases.Postoperative bile leakage occurred in 6 patients(46.2%),with bile leakage resolving in 5 patients within 7 to 27 d after surgery through the bile duct and abdominal drainage and in 1 patient within 56 d after the operation.There were no perioperative deaths.Cholangiography imaging was performed in 7 patients,with no signs of bile leakage,bile duct stricture,or bile duct stones observed.Two patients underwent bile duct endoscopy,showing no demarcation between the bile duct mucosa and the serosa of the round ligament of the liver.The follow-up period ranged from 3 months to 14 years.One patient exhibited mild dilatation of the left intrahepatic bile duct,possibly due to stricture at the left hepatic duct repair site,The other 12 patients showed no stricture or cystic dilatation at the repair site.Conclusion:Repairing bile duct defects with the serosal surface of the round ligament of the liver has a good effect and is simple and easy to perform,which is worthy of clinical promotion and application.