Heidenhain C, Rosch R, Neumann U P
Chirurgische Klinik und Poliklinik, Universitätsklinikum der RWTH Aachen, Deutschland.
Chirurg. 2011 Jan;82(1):7-10, 12-3. doi: 10.1007/s00104-010-1902-x.
The success of hepatobiliary anastomoses is influenced by the diameter of the bile duct, the location within the biliary tract, the situation of primary or revision surgery and accompanying infections. The exact preoperative diagnostics of the anatomy of the biliary tract are indispensable for low complication rates. Within reconstructive surgery, hepaticojejunostomy has been established as the standard technique and a biliodigestive anastomosis is performed proximal to the cystic duct and 2-3 cm below the fork in the hepatic duct. In general, end-to-end anastomoses of the common bile duct are not recommended due to the high risk for stenosis. Within the liver hilus an exact preparation of all tubular structures is mandatory. With regard to possible perioperative complications operations on the hepatic duct or segmental bile ducts should be performed in specialized centers. Methods of drainage in hepatobiliary surgery are percutaneous transhepatic cholangiodrainage (PTCD), internal-external drainage, internal drainage with endoscopic or surgically placed stents, external-internal-external drainage and the T-drain.
肝胆吻合术的成功受胆管直径、在胆道系统中的位置、初次手术或翻修手术情况以及伴随感染的影响。术前对胆道解剖结构进行准确诊断对于降低并发症发生率必不可少。在重建手术中，肝空肠吻合术已成为标准术式，胆肠吻合术在胆囊管近端、肝管分叉下方2 - 3厘米处进行。一般而言，由于狭窄风险高，不建议行胆总管端端吻合术。在肝门处，必须精确解剖所有管状结构。鉴于可能出现的围手术期并发症，肝管或肝段胆管手术应在专业中心进行。肝胆外科的引流方法有经皮经肝胆管引流术（PTCD）、内外引流、内镜或手术置入支架的内引流、外 - 内 - 外引流以及T形引流。
