Biglari M, Van den Bussche D, Vanlangenhove P
Department of General Surgery, Sint Andries Hospital Tielt, Belgium.
Acta Chir Belg. 2013 Jul-Aug;113(4):308-10. doi: 10.1080/00015458.2013.11680935.
Hepaticojejunostomy is the standard technique for the reconstruction of severe iatrogenic lesions of the common bile duct (CBD), although the technique itself is major surgery with a complication rate up to 30%. We report a case of a male patient with a iatrogenic complete transsection of the CBD. Due to multiple previous operations and the present inflammation a standard reconstruction technique was not possible to perform. A neo-bile duct was created using a segment of the Great Saphenous Vein (GSV) synchronously with an external biliary drainage by PTCA and biliary stenting (after 4 weeks). The stent was removed 8 months later. Cholangiography showed normal bile flow without occlusion. Blood tests normalised. We believe that using an autologous vein graft in combination with a removable or biodegradable stent is the right track for the reconstruction of the CBD in the future.
肝空管空空肠吻合术是重建胆总管严重医源性损伤的标准技术，尽管该技术本身属于大手术，并发症发生率高达30%。我们报告一例男性患者，其胆总管发生医源性完全横断。由于既往多次手术以及目前存在炎症，无法实施标准的重建技术。利用一段大隐静脉构建了一条新胆管，同时通过经皮肝穿刺胆管引流术（PTCA）和胆管支架置入术进行外引流（4周后）。8个月后取出支架。胆管造影显示胆汁流动正常，无梗阻。血液检查结果恢复正常。我们认为，将自体静脉移植物与可移除或可生物降解支架相结合，是未来重建胆总管的正确方向。
