Ando H
Department of Pediatric Surgery, Nagoya University School of Medicine, Japan.
Nagoya J Med Sci. 1999 Nov;62(3-4):107-14.
An improved operative technique to transect the fibrous cord by dividing the ligamentum venosum (Arantius' canal) is described for noncorrectable biliary atresia. The Arantius' canal is situated cranial and posterior side to the bifurcation of the umbilical portion and the portal branch of the Quinous' segment 3. The portal vein is fully mobile and the porta hepatis can be widely exposed by dividing the Arantius' canal. The fibrous cord of the porta hepatis can easily be dissected posteriorly and laterally where there is an extensive number of bile ducts. Eight patients with biliary atresia underwent this procedure. Jaundice resolved completely (serum total bilirubin concentration: < or = 1 mg/dl) in 7 patients within 40 days. Postoperative cholangitis did not occur. By dividing the Arantius' canal, the portal vein comes free from the portal fissure to make the hepatic hilum wider, and surgeons are able to work within a larger porta hepatic space without causing portal vein compression. Free drainage of the bile from the porta hepatis may prevent postoperative cholangitis and promote resolution of jaundice.
本文描述了一种用于不可纠正性胆道闭锁的改良手术技术，即通过切断静脉韧带（阿朗蒂乌斯管）来横断纤维索。阿朗蒂乌斯管位于脐部与奎努斯第3段门静脉分支分叉处的头侧和后侧。门静脉完全可移动，通过切断阿朗蒂乌斯管可广泛暴露肝门。肝门纤维索在有大量胆管的后方和外侧很容易被解剖。8例胆道闭锁患者接受了该手术。7例患者在40天内黄疸完全消退（血清总胆红素浓度≤1mg/dl）。术后未发生胆管炎。通过切断阿朗蒂乌斯管，门静脉从门静脉裂中游离出来，使肝门变宽，外科医生能够在更大的肝门空间内操作而不会导致门静脉受压。肝门胆汁的自由引流可能预防术后胆管炎并促进黄疸消退。
