Wen Zhe, Cheng Wei, Liang Qifeng, Liu Tao, Liang Jiankun, Zhang Bingbing, Xu Yiping
1Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, China.
2Department of Surgery, United Family Healthcare, Beijing, China.
J Laparoendosc Adv Surg Tech A. 2019 Aug;29(8):1060-1066. doi: 10.1089/lap.2019.0026. Epub 2019 Jul 17.
This study assessed the diagnostic protocol and the outcomes of laparoscopic aberrant hepatic duct (AHD) reconstruction in choledochal cyst (CC) surgery. From January 2010 to January 2018, 275 laparoscopic CC excisions were conducted in our hospital. Seven patients of CC with associated AHD were recorded. AHDs that drained into the cystic duct were anastomosed to the Roux-en-Y loop. Clinical data of these 7 patients were retrospectively analyzed. AHD is classified into four types according to the literature. The type where AHD drains into the cystic duct is the most commonly encountered one. The incidence of this type was 2.5% (7/275) in our series. Preoperative examination included magnetic resonance cholangiopancreatography (MRCP) (5 patients) and computed tomography (CT) scan (2 patients). Suspected AHD was diagnosed preoperatively in 4 out of the 5 patients who underwent MRCP. For the 2 patients who underwent CT scan only, AHD was not detected preoperatively. AHD was verified intraoperatively for all the 4 patients who had suspected diagnosis. Among them, AHD was well preserved in 3 patients, but damaged at exploration in the remaining 1. For the remaining 3 patients without preoperative AHD diagnosis, bile leakage was detected intraoperatively. Ductoplasty of the AHD with common hepatic duct was performed in 3 patients, and AHD was incorporated into the Roux-en-Y jejunal loop separately in 4 patients. Laparoscopic surgical procedures were completed in 6 of the 7 patients in this study, while 1 patient was converted into an open procedure. Postoperative recovery was uneventful in all patients. The duration of follow-up ranged from 6 months to 4 years (median 2 years) with no complication encountered. Routine preoperative MRCP examination of CC is recommended to detect variations of biliary tree. The laparoscopic approach is a feasible option in the experienced hands.
本研究评估了胆管囊肿（CC）手术中腹腔镜下异常肝管（AHD）重建的诊断方案及手术结果。2010年1月至2018年1月，我院共进行了275例腹腔镜下CC切除术。记录了7例合并AHD的CC患者。将汇入胆囊管的AHD与Roux-en-Y袢进行吻合。对这7例患者的临床资料进行回顾性分析。根据文献，AHD分为四种类型。AHD汇入胆囊管的类型最为常见。在我们的系列研究中，该类型的发生率为2.5%（7/275）。术前检查包括磁共振胰胆管造影（MRCP）（5例患者）和计算机断层扫描（CT）（2例患者）。在接受MRCP检查的5例患者中，有4例术前诊断为疑似AHD。对于仅接受CT扫描的2例患者，术前未检测到AHD。在所有4例疑似诊断的患者中，术中均证实存在AHD。其中，3例患者的AHD保存良好，但其余1例在探查时受损。对于其余3例术前未诊断出AHD的患者，术中发现胆汁漏。3例患者行AHD与肝总管的胆管成形术，4例患者将AHD分别纳入Roux-en-Y空肠袢。本研究中的7例患者中有6例完成了腹腔镜手术，1例转为开放手术。所有患者术后恢复顺利。随访时间为6个月至4年（中位时间2年），未出现并发症。建议对CC患者进行常规术前MRCP检查以检测胆道树的变异情况。在经验丰富的医生手中，腹腔镜手术是一种可行的选择。
