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3a型胆管变异活体供者的纯腹腔镜供体右肝切除术:一例报告

Pure laparoscopic donor right hepatectomy in a living donor with type 3a biliary variation: A case report.

作者信息

Han Young Seok, Ha Heontak, Kwon Hyung Jun, Chun Jae Min

机构信息

Department of Surgery, Kyungpook National University School of Medicine, Jung-gu, Daegu, Republic of Korea.

出版信息

Medicine (Baltimore). 2017 Sep;96(38):e8076. doi: 10.1097/MD.0000000000008076.

Abstract

RATIONALE

With refinements in the operative technique, laparoscopic surgery has become the standard practice for liver resection. In the field of living donor liver transplantation, a few centers adopted laparoscopic surgery as an alternative to conventional open donor hepatectomy, and the application of pure laparoscopic donor right hepatectomy has been limited to the donors with simple, favorable biliary anatomy.

PATIENT CONCERNS

The candidate donor was a 19-year-old woman with type 3a bile duct variation.

INTERVENTIONS

After confirming precise cutting points under the guidance of a radiopaque marker rubber band, the bile ducts were divided and the remnant stumps were closed with suture and clipping using Hem-o-lok, respectively.

OUTCOMES

The postoperative course was uneventful and she was satisfactory 6 months after surgery.

LESSONS

A laparoscopic donor hepatectomy for the living donor with biliary variation was feasible. Biliary variations are commonly encountered during living donor surgery, and we think that such variations in laparoscopic donor hepatectomy need to be overcome to expand the selection criteria.

摘要

理论依据

随着手术技术的改进,腹腔镜手术已成为肝切除术的标准术式。在活体肝移植领域,少数中心采用腹腔镜手术替代传统的开放性供体肝切除术,而单纯腹腔镜供体右半肝切除术的应用仅限于胆道解剖结构简单、良好的供体。

患者情况

候选供体是一名19岁的女性,胆管变异为3a型。

干预措施

在不透射线的标记橡皮筋引导下确定精确的切割点后,分别离断胆管,残端用缝线缝合并用Hem-o-lok夹闭。

结果

术后过程顺利,术后6个月情况良好。

经验教训

为胆管变异的活体供体进行腹腔镜供体肝切除术是可行的。胆管变异在活体供体手术中很常见,我们认为要扩大选择标准,就需要克服腹腔镜供体肝切除术中的此类变异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fa2d/5617712/5e04ac8598bd/medi-96-e8076-g001.jpg

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