背景:根治性切除术是肺门周围肿瘤最有效的治疗方法。切除后胆道重建是该手术的关键步骤之一。传统上进行粘膜-粘膜胆管空肠造口术,其中切除边缘的胆管分别与空肠吻合。然而,这种方法手术时间长,术后并发症风险高。本研究提出了一种改良的肝空肠吻合术技术及其结果。
方法:在肝胆外科使用改良技术进行肝空肠造口术的患者的数据,大坪医院,陆军医科大学,重庆,中国,2016年1月至2021年12月,进行回顾性分析。
结果:在研究期间,共有13例肺门周围肿瘤患者使用改良的肝空肠造口术进行了R0切除和胆肠重建。在操作过程中,胆管树桩的排列得到改善,吻合口的后壁被加固,内部支架放置在较小的胆管中,将外部支架放置在较大的胆管中,使用4-0prolene进行肝空肠吻合术。术后无严重并发症,如死亡或胆漏,发生在住院期间。此外,随访6个月后,无胆道狭窄或胆管炎病例.
结论:改良肝空肠吻合术是一种安全有效的肝门部肿瘤切除术后胆道重建技术。对于切除后需要重建的多个胆管的困难病例,可以很容易地执行此操作。
BACKGROUND: Radical resection is the most effective treatment for perihilar tumors. Biliary tract reconstruction after resection is one of the key steps in this surgery. Mucosa-to-mucosa cholangiojejunostomy is traditionally performed, in which the bile ducts at the resection margin are separately anastomosed to the jejunum. However, this approach is associated with long operative time and high risk of postoperative complications. The present study presents a modified technique of hepatojejunostomy and its outcomes.
METHODS: The data of patients who underwent hepatojejunostomy using the modified technique at the Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, China, from January 2016 to December 2021, were retrospectively analyzed.
RESULTS: A total of 13 patients with perihilar tumors underwent R0 resection and bilioenteric reconstruction using the modified hepatojejunostomy technique during the study period. During the operation, the alignment of the bile duct stumps was improved, the posterior wall of the anastomosis was reinforced, internal stents were placed in the smaller bile ducts, external stents were placed in the larger bile ducts, and hepatojejunostomy was performed using 4 - 0 prolene. No serious postoperative complications, such as death or bile leakage, occurred during the hospitalization. Furthermore, there were no cases of biliary stricture or cholangitis after the six-month follow-up period.
CONCLUSIONS: The modified hepatojejunostomy technique is a safe and effective technique of biliary reconstruction after the resection of perihilar tumors. This can be easily performed for difficult cases with multiple bile ducts that require reconstruction after resection.