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供体左肝切除术后胆管狭窄的磁压缩吻合术:一例报告

Magnetic compression anastomosis for bile duct stenosis after donor left hepatectomy: a case report.

作者信息

Oya H, Sato Y, Yamanouchi E, Yamamoto S, Hara Y, Kokai H, Sakamoto T, Miura K, Shioji K, Aoyagi Y, Hatakeyama K

机构信息

Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

出版信息

Transplant Proc. 2012 Apr;44(3):806-9. doi: 10.1016/j.transproceed.2012.01.021.

Abstract

Magnetic compression anastomosis (MCA) provides a minimally invasive treatment creating a nonsurgical, sutureless enteric anastomosis in conjunction with an interventional radiologic technique by using 2 high-power magnets. Recently, the MCA technique has been applied to bile duct strictures after living donor liver transplantation or major hepatectomy. Herein we described use of MCA for bile duct stenosis 5 months after donor left hepatectomy in a 24-year-old man who presented with a stricture at the porta hepatis and intrahepatic bile duct dilatation. Unsuccessful transpapillary biliary drainage and balloon dilatation through a percutaneous transhepatic biliary drainage (PTBD) route led to the MCA. A 4-mm-diameter cylindrical samarium-cobalt (Sm-Co) daughter magnet with a long nylon wire was placed at the superior site of the obstruction through the PTBD route. A 5-mm-diameter Sm-Co parent magnet with an attached nylon handle was endoscopically inserted into the common bile duct and placed at the inferior site of obstruction. The 2 magnets were attracted, sandwiching the stricture and establishing a reanastomosis. In conclusion, the MCA technique was a unique procedure for choledochocholedochostomy in a patient with bile duct stenosis after donor hepatectomy.

摘要

磁性压缩吻合术(MCA)提供了一种微创治疗方法,通过使用两个高功率磁体,结合介入放射技术,创建一个非手术、无缝合的肠吻合术。最近,MCA技术已应用于活体供肝移植或肝大部切除术后的胆管狭窄。在此,我们描述了一名24岁男性在供体左肝切除术后5个月因肝门部狭窄和肝内胆管扩张出现胆管狭窄时使用MCA的情况。经乳头胆管引流和通过经皮经肝胆管引流(PTBD)途径进行的球囊扩张均未成功,从而采用了MCA。通过PTBD途径将一个带有长尼龙线的直径4毫米的圆柱形钐钴(Sm-Co)子磁体放置在梗阻的上方部位。将一个带有尼龙手柄的直径5毫米的Sm-Co母磁体通过内镜插入胆总管,并放置在梗阻的下方部位。两个磁体相互吸引,夹住狭窄部位并建立再吻合。总之,MCA技术是供肝切除术后胆管狭窄患者进行胆总管-胆总管吻合术的一种独特方法。

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