Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, 100 Bd du Général Leclerc, 92110, Clichy, France.
Assistance Publique Hôpitaux de Paris, University Paris VII Denis Diderot, 92110, Clichy, France.
J Gastrointest Surg. 2017 Sep;21(9):1540-1543. doi: 10.1007/s11605-017-3485-z. Epub 2017 Jul 10.
Lateral injury of the bile duct can occur after cholecystectomy, bile duct dissection, or exploration. If direct repair is not possible, conversion to bilioenteric anastomosis can be needed with the risk of long-term bile duct infections and associated complications. We developed a new surgical technique which consist of reconstructing the bile duct with the round ligament. The vascularized round ligament is completely mobilized until its origin and used for lateral reconstruction of the bile duct to cover the defect. T tube was inserted and removed after few months. Patency of the bile duct was assessed by cholangiography, the liver function test and magnetic resonance imaging (MRI). Two patients aged 33 and 59 years old underwent lateral reconstruction of the bile duct for defects secondary to choledocotomy for stone extraction or during dissection for Mirizzi syndrome. The defects measured 2 and 3 cm and occupied half of the bile duct circumference. The postoperative course was marked by low output biliary fistula resolved spontaneously. In one patient, the T tube was removed at 3 months after surgery and MRI at 9 months showed strictly normal aspect of the bile duct with normal liver function test. The second patient is going very well 2 months after surgery and the T tube is closed. Lateral reconstruction of the bile duct can be safely achieved with the vascularized round ligament. We will extend our indications to tubular reconstruction.
胆管的侧方损伤可发生于胆囊切除术后、胆管解剖或探查后。如果无法直接修复，则可能需要转换为胆肠吻合术，这可能会导致长期胆管感染和相关并发症。我们开发了一种新的手术技术，即用圆韧带重建胆管。充分游离血运良好的圆韧带，直至其起源处，用于胆管的侧方重建，以覆盖缺损部位。术后几个月可拔除 T 管。通过胆管造影、肝功能检查和磁共振成像（MRI）评估胆管通畅性。两名年龄分别为 33 岁和 59 岁的患者因胆总管切开取石术或 Mirizzi 综合征解剖过程中出现的胆管缺损而接受胆管侧方重建术。缺损大小分别为 2cm 和 3cm，占胆管周长的一半。术后过程中出现低流量胆瘘，自发性缓解。在一名患者中，术后 3 个月拔除 T 管，术后 9 个月的 MRI 显示胆管形态完全正常，肝功能检查正常。另一名患者术后 2 个月恢复良好，T 管已关闭。用血运良好的圆韧带可安全地进行胆管侧方重建。我们将把适应证扩展到管状重建。
