Kimura Koichi, Ikegami Toru, Yamashita Yo-ichi, Saeki Hiroshi, Oki Eiji, Yoshizumi Tomoharu, Uchiyama Hideaki, Kawanaka Hirofumi, Soejima Yuji, Morita Masaru, Shirabe Ken, Ikeda Tetsuo, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
Fukuoka Igaku Zasshi. 2013 Sep;104(9):309-14.
Biliary leakage is a major complication after hepatectomy. We report the case of a living-donor liver transplantation (LDLT) donor with a late-onset bile leak from the trifurcation of the hepatic duct who was successfully treated using rendezvous technique. A 52-year-old man underwent extended left hepatectomy for donation and was discharged on postoperative day (PD) 13. However, he was rehospitalized on PD 26 with severe abdominal pain. Physical examination suggested panperitonitis, and abdominocentesis showed bilious ascites. Emergent laparotomy for biliary leakage and peritonitis was performed. There was bilious ascites in the peritoneal cavity. A biliary fistula was recognized at the trifurcation of B8a, B8b, and B5. Intraoperative transhepatic biliary drainage of each bile duct was performed. Endoscopic transpapillary drainage was performed on PD 24. Finally, external drains were removed and complete internal drainage established on PD 70. The bile leak was considered to be the result of injury from electrocautery device. Appropriate making choices of the electrocautery devices enable us to avoid over thermal injury of the liver surface. Rendezvous bidirectional drainage effectively treated late-onset bile leakage from the trifurcation of a hepatic bile duct.
胆漏是肝切除术后的一种主要并发症。我们报告了一例活体肝移植（LDLT）供体，其肝管三叉处出现迟发性胆漏，采用会师技术成功治疗。一名52岁男性接受了扩大左肝切除术用于供肝，术后第13天出院。然而，他在术后第26天因严重腹痛再次入院。体格检查提示全腹膜炎，腹腔穿刺抽出胆汁性腹水。因胆漏和腹膜炎紧急行剖腹探查术。腹腔内有胆汁性腹水。在B8a、B8b和B5的三叉处发现一个胆瘘。术中对各胆管进行了经肝胆汁引流。在术后第24天行内镜下经乳头引流。最后，在术后第70天拔除了外部引流管并建立了完全的内引流。胆漏被认为是电灼设备损伤的结果。正确选择电灼设备能使我们避免肝脏表面的过度热损伤。会师双向引流有效地治疗了肝内胆管三叉处的迟发性胆漏。
