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胰十二指肠切除术后副胆管漏的处理：一种采用经皮和内镜会师的新方法

Management of an Accessory Bile Duct Leak Following Pancreaticoduodenectomy: A Novel Approach Utilizing a Percutaneous and Endoscopic Rendezvous.

作者信息

Rapp George A, Nelson Kari J, Imagawa David K, Huang Jason Y, Lee John G

机构信息

Department of Radiology, UC Irvine Medical Center, Irvine, CA.

Department of Surgery, UC Irvine Medical Center, Irvine, CA.

出版信息

ACG Case Rep J. 2017 Jan 4;4:e2. doi: 10.14309/crj.2017.2. eCollection 2017.

DOI:10.14309/crj.2017.2
PMID:28138446
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5244888/
Abstract

Biliary leaks are uncommon but morbid complications of pancreaticoduodenectomies, which have historically been managed with percutaneous drainage, reoperation, or a combination of both. We report a de novo percutaneous-endoscopic hepaticojejunostomy from an anomalous right hepatic duct injured during pancreaticoduodenectomy to the afferent bowel limb. The percutaneous-endoscopic hepaticojejunostomy was stented to allow for tract formation with successful stent removal after 5.5 months. One year after the creation of the percutaneous-endoscopic hepaticojejunostomy, the patient remains clinically well without evidence of biliary leak or obstruction.

摘要

胆漏是胰十二指肠切除术罕见但严重的并发症，以往一直通过经皮引流、再次手术或两者结合来处理。我们报告了一例从胰十二指肠切除术中受损的异常右肝管到输入肠袢的全新经皮内镜下肝空肠吻合术。经皮内镜下肝空肠吻合术置入了支架以形成通道，5.5个月后成功取出支架。经皮内镜下肝空肠吻合术实施一年后，患者临床状况良好，无胆漏或梗阻迹象。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8d5/5244888/1290d46766cb/CG-CGCR160108F005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8d5/5244888/b36d3279489e/CG-CGCR160108F001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8d5/5244888/7fe07593ec98/CG-CGCR160108F002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8d5/5244888/b2f2d8e30a66/CG-CGCR160108F003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8d5/5244888/e64bdb38dac3/CG-CGCR160108F004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8d5/5244888/1290d46766cb/CG-CGCR160108F005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8d5/5244888/b36d3279489e/CG-CGCR160108F001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8d5/5244888/7fe07593ec98/CG-CGCR160108F002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8d5/5244888/b2f2d8e30a66/CG-CGCR160108F003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8d5/5244888/e64bdb38dac3/CG-CGCR160108F004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8d5/5244888/1290d46766cb/CG-CGCR160108F005.jpg

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本文引用的文献

1
Retrograde Percutaneous Transjejunal Creation of Biliary Neoanastomoses in Patients with Complete Hepaticojejunostomy Dehiscence.完全性肝空肠吻合口裂开患者逆行经皮经空肠胆管新吻合术的建立
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Percutaneous transhepatic biliary drainage in patients with postsurgical bile leakage and nondilated intrahepatic bile ducts.经皮经肝胆道引流术治疗术后胆漏且肝内胆管无扩张患者。
Dig Surg. 2013;30(4-6):444-50. doi: 10.1159/000356711. Epub 2014 Jan 14.
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Transhepatic anterograde biliary drainage using a self-expandable metallic stent: A therapeutic alternative after hepaticojejunostomy with Roux-en-Y reconstruction.
使用自膨式金属支架进行经肝顺行性胆道引流：肝空肠吻合术联合Roux-en-Y重建术后的一种治疗选择。
Rev Esp Enferm Dig. 2013 Jul;105(6):363-5. doi: 10.4321/s1130-01082013000600010.
4
Endoscopic ultrasonography-guided cholecystogastrostomy using a lumen-apposing metal stent as an alternative to extrahepatic bile duct drainage in pancreatic cancer with duodenal invasion.内镜超声引导下使用 lumen-apposing 金属支架进行胆囊胃吻合术，作为十二指肠侵犯型胰腺癌的肝外胆管引流的替代方法。
Dig Endosc. 2013 May;25 Suppl 2:137-41. doi: 10.1111/den.12084.
5
Two decades of percutaneous transjejunal biliary intervention for benign biliary disease: a review of the intervention nature and complications.经皮经十二指肠胆道介入治疗良性胆道疾病：介入性质和并发症的回顾。
Insights Imaging. 2011 Oct;2(5):557-65. doi: 10.1007/s13244-011-0119-y. Epub 2011 Jul 28.
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One thousand consecutive pancreaticoduodenectomies.一千例连续的胰十二指肠切除术。
Ann Surg. 2006 Jul;244(1):10-5. doi: 10.1097/01.sla.0000217673.04165.ea.
7
Anatomic variation in intrahepatic bile ducts: an analysis of intraoperative cholangiograms in 300 consecutive donors for living donor liver transplantation.肝内胆管的解剖变异：对300例连续活体肝移植供体术中胆管造影的分析。
Korean J Radiol. 2003 Apr-Jun;4(2):85-90. doi: 10.3348/kjr.2003.4.2.85.
8
Percutaneous hepaticojejunostomy with use of a metal stent for injury of the right hepatic duct after laparoscopic cholecystectomy.腹腔镜胆囊切除术后右肝管损伤采用金属支架的经皮肝空肠吻合术
J Vasc Interv Radiol. 2003 Apr;14(4):509-12. doi: 10.1097/01.rvi.rvi.0000064842.87207.be.
9
Isolated right segmental hepatic duct injury: a diagnostic and therapeutic challenge.孤立性右肝段胆管损伤：诊断与治疗挑战
J Gastrointest Surg. 2000 Mar-Apr;4(2):168-77. doi: 10.1016/s1091-255x(00)80053-0.
10
Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts.非扩张性肝内胆管患者的经皮胆道引流
AJR Am J Roentgenol. 1999 Dec;173(6):1541-4. doi: 10.2214/ajr.173.6.10584798.