O'Suilleabhain Criostoir B, Madhavan Krishna K
Department of Surgery, Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh EH3 9YW, Scotland, United Kingdom.
Am J Surg. 2004 Jan;187(1):131-3. doi: 10.1016/j.amjsurg.2002.11.005.
Segment III bypass can achieve excellent palliation in jaundiced patients with unresectable malignancy of the hepatic duct confluence. However, the long-term benefits are often offset by early morbidity and mortality associated with surgery. Bile leakage is a common postoperative complication. Several approaches to the segment III duct have been described. The "round ligament approach" identifies the segment III duct by following the round ligament into the recessus of Rex, in the umbilical fissure. It is the approach adopted by most units, including our own. The liver is often split to a depth of 5 to 6 cm to expose the duct. Fashioning an intrahepatic cholangiojejunostomy within the recess of the umbilical fissure can be technically difficult due to lack of space. We describe a modification of the round ligament approach, creating a long and tension-free cholangiojejunostomy, which we believe reduces the incidence of postoperative bile leakage.
三段胆管旁路术可使肝门部不可切除恶性肿瘤所致黄疸患者获得良好的减黄效果。然而，手术早期的发病率和死亡率往往抵消了其长期益处。胆漏是常见的术后并发症。已有多种处理三段胆管的方法被描述。“圆韧带入路”是通过沿圆韧带进入脐裂的雷氏隐窝来识别三段胆管。这是包括我们单位在内的大多数医疗单位所采用的方法。肝脏通常要劈开至5至6厘米深以暴露胆管。由于空间不足，在脐裂隐窝内制作肝内胆管空肠吻合术在技术上可能具有挑战性。我们描述了一种对圆韧带入路的改良方法，可创建一个长且无张力的胆管空肠吻合术，我们认为这可降低术后胆漏的发生率。
