Shimizu Hiroaki, Kimura Fumio, Yoshidome Hiroyuki, Ohtsuka Masayuki, Kato Atsushi, Yoshitomi Hideaki, Nozawa Satoshi, Furukawa Katunori, Mitsuhashi Noboru, Takeuchi Dan, Takayashiki Tukasa, Suda Kosuke, Miyazaki Masaru
Department of General Surgery, Chiba University, Chiba, Japan.
Hepatogastroenterology. 2012 Jun;59(116):1023-5. doi: 10.5754/hge08093.
Interventional procedure via percutaneous transhepatic route is often performed, as an initial treatment, in patients with benign bilioenteric anastomotic stricture. However, surgical management is required in most cases in which radiological intervention is unsuccessful. In this report, we describe a case of a 67-year-old woman with recurrent bilioenteric anastomotic stricture, accompanying bilateral hepatolitiasis after several times of transhepatic interventions. The patient underwent intrahepatic cholangiojejunostomy (Longmire procedure) and cholangioscopic lithotomy after resection of an atrophic left lateral segment resulting from hepatolithiasis. Although the damaged hilar bile duct had to be isolated and divided from the corresponding vasculature for re-anastomosis, it was quite impossible due to severe inflammatory change at the hepatic hilus. We, therefore, anastomosed the intact biliary stump on the cut surface of the left lateral segment to the jejunal loop with a stent tube. The patient's postoperative course was uneventful and she exhibited no evidence of cholangitis during follow-up period of 1 year after surgery. At present, the indications for intrahepatic cholangiojejunostomy for biliary obstruction, are quite limited, but biliary surgeons should keep this procedure in mind at the time of biliary reconstruction for benign proximal bile duct stricture, particularly in cases of multiply operated hilum.
对于良性胆肠吻合口狭窄患者，经皮经肝途径的介入治疗常作为初始治疗方法。然而，在大多数放射介入治疗失败的情况下，需要进行手术治疗。在本报告中，我们描述了一例67岁女性患者，在多次经肝介入治疗后出现复发性胆肠吻合口狭窄，并伴有双侧肝内胆管结石。患者在切除因肝内胆管结石导致的萎缩性左外侧段后，接受了肝内胆管空肠吻合术（朗迈尔手术）和胆管镜取石术。尽管为了重新吻合，受损的肝门部胆管必须与相应的血管分离，但由于肝门部严重的炎症改变，这几乎是不可能的。因此，我们将左外侧段切面上完整的胆管残端与带有支架管的空肠袢进行了吻合。患者术后恢复顺利，在术后1年的随访期间未出现胆管炎迹象。目前，肝内胆管空肠吻合术治疗胆道梗阻的适应证相当有限，但胆道外科医生在进行良性近端胆管狭窄的胆道重建时，应牢记这一手术方法，特别是在多次手术的肝门部病例中。
