Abstract：
The diseased bile duct in bilobar congenital biliary dilatation is extensive and often requires major hepatectomy or liver transplantation associated with a higher risk. We aimed to evaluate the safety and benefit of modified mesohepatectomy, in comparison with trisectionectomy, to treat bilobar congenital biliary dilatation.
This study included 28 patients with type IV and V bilobar congenital biliary dilatation. An innovative mesohepatectomy comprising the hepatectomy technique beyond the P/U point and bile duct shaping was applied to 14 patients to address the extensively diseased bile duct and difficulty in hepaticojejunostomy. Another 14 patients received trisectionectomy. The perioperative and long-term outcomes of these patients were compared.
The ratio of residual liver volume to standard liver volume in the mesohepatectomy group was higher (78.68% vs. 40.90%, p = 0.005), while the resection rate of the liver parenchyma was lower (28.25% vs. 63.97%, p = 0.000), than that in trisectionectomy group. The mesohepatectomy group had a lower severe complication (>Clavein III, 0% vs. 57.70%, p = 0.019) and incidence of posthepatectomy liver failure (7.14% vs. 42.86%, p = 0.038). No significant difference was observed in blood loss and bile leakage (p > 0.05). All the patients in the mesohepatectomy group achieved optimal results in the long-term follow-up.
mesohepatectomy provides an efficient treatment option for bilobar congenital biliary dilatation and can achieve radical resection, retain more liver parenchyma, and reduce the difficulty of hepaticojejunostomy, especially for patients that are not eligible for major hepatectomy and liver transplantation.
This study included 28 patients with type IV and V bilobar congenital biliary dilatation. An innovative mesohepatectomy comprising the hepatectomy technique beyond the P/U point and bile duct shaping was applied to 14 patients to address the extensively diseased bile duct and difficulty in hepaticojejunostomy. Another 14 patients received trisectionectomy. The perioperative and long-term outcomes of these patients were compared.
The ratio of residual liver volume to standard liver volume in the mesohepatectomy group was higher (78.68% vs. 40.90%, p = 0.005), while the resection rate of the liver parenchyma was lower (28.25% vs. 63.97%, p = 0.000), than that in trisectionectomy group. The mesohepatectomy group had a lower severe complication (>Clavein III, 0% vs. 57.70%, p = 0.019) and incidence of posthepatectomy liver failure (7.14% vs. 42.86%, p = 0.038). No significant difference was observed in blood loss and bile leakage (p > 0.05). All the patients in the mesohepatectomy group achieved optimal results in the long-term follow-up.
mesohepatectomy provides an efficient treatment option for bilobar congenital biliary dilatation and can achieve radical resection, retain more liver parenchyma, and reduce the difficulty of hepaticojejunostomy, especially for patients that are not eligible for major hepatectomy and liver transplantation.
摘要：
背景：双叶先天性胆管扩张的病变胆管广泛，通常需要进行大肝切除术或肝移植，风险更高。我们的目的是评估改良中肝切除术的安全性和益处，与三节切除术相比，治疗双叶先天性胆道扩张症。
方法：本研究包括28例IV型和V型双叶先天性胆道扩张患者。对14例患者进行了创新的肝中膜切除术，其中包括P/U点以外的肝切除术技术和胆管整形，以解决广泛患病的胆管和肝空肠吻合术的困难。另有14名患者接受了三部分切除术。比较这些患者的围手术期和长期预后。
结果：中肝切除术组的残余肝体积与标准肝体积的比率更高（78.68％vs.40.90%,p=0.005),而肝实质切除率较低(28.25%vs.63.97%,p=0.000)，比三节切除术组要多。肝中膜切除术组的严重并发症较低（>ClaveinIII，0%vs.57.70%,p=0.019)和切除术后肝功能衰竭的发生率(7.14%vs.42.86%,p=0.038)。在失血和胆漏方面没有观察到显著差异(p>0.05)。在长期随访中，肝系膜切除术组的所有患者均达到最佳效果。
结论：肝系膜切除术为双叶先天性胆道扩张提供了一种有效的治疗选择，可以实现根治性切除，保留更多的肝实质，减少肝空肠吻合术的难度，特别是对于不适合进行肝切除术和肝移植的患者。
方法：本研究包括28例IV型和V型双叶先天性胆道扩张患者。对14例患者进行了创新的肝中膜切除术，其中包括P/U点以外的肝切除术技术和胆管整形，以解决广泛患病的胆管和肝空肠吻合术的困难。另有14名患者接受了三部分切除术。比较这些患者的围手术期和长期预后。
结果：中肝切除术组的残余肝体积与标准肝体积的比率更高（78.68％vs.40.90%,p=0.005),而肝实质切除率较低(28.25%vs.63.97%,p=0.000)，比三节切除术组要多。肝中膜切除术组的严重并发症较低（>ClaveinIII，0%vs.57.70%,p=0.019)和切除术后肝功能衰竭的发生率(7.14%vs.42.86%,p=0.038)。在失血和胆漏方面没有观察到显著差异(p>0.05)。在长期随访中，肝系膜切除术组的所有患者均达到最佳效果。
结论：肝系膜切除术为双叶先天性胆道扩张提供了一种有效的治疗选择，可以实现根治性切除，保留更多的肝实质，减少肝空肠吻合术的难度，特别是对于不适合进行肝切除术和肝移植的患者。
