Mercado M A, Orozco H, de la Garza L, López-Martínez L M, Contreras A, Guillén-Navarro E
Department of Surgery, National Institute of Nutrition, Salvador Zubirán, Tlalpan, Mexico.
Arch Surg. 1999 Sep;134(9):1008-10. doi: 10.1001/archsurg.134.9.1008.
A technique for intrahepatic reconstruction of the biliary tree after complex high injuries is described. The fundament of the procedure is the removal of a wedge of segment IV at the level of the hilar plate. When the hilar plate is reached and no adequate exposure of the ducts can be obtained, removing a 1 x 1-in wedge of segment IV between the gallbladder bed and the round ligament exposes the left and right ducts. An anteroposterior view of the plate is obtained instead of a caudocephalic dissection, exposing healthy, nonscarred ducts for reconstruction. We have used this approach in 22 patients, and adequate exposure of the ducts has been obtained, with a high success rate of patency of the anastomosis at a mean follow-up of 3 years. Twenty patients have a patent anastomosis, with a good quality of life and no restenosis.
本文描述了一种用于复杂高位肝内胆管损伤后肝内胆管树重建的技术。该手术的基础是在肝门板水平切除IV段的楔形组织。当到达肝门板且无法充分暴露胆管时，在胆囊床和圆韧带之间切除IV段1×1英寸的楔形组织，可暴露左右肝管。通过这种方式可获得肝门板的前后位视野，而不是进行尾头方向的解剖，从而暴露健康、无瘢痕的胆管用于重建。我们已将此方法应用于22例患者，均获得了充分的胆管暴露，平均随访3年时吻合口通畅率很高。20例患者的吻合口通畅，生活质量良好且无再狭窄。
