自体肝移植治疗终末期肝泡型包虫病的个体化胆道重建技术。

Individualized biliary reconstruction techniques in autotransplantation for end-stage hepatic alveolar echinococcosis.

机构信息

Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China; Department of Hepatobiliary Surgery, Mianyang Central Hospital, Sichuan, Mianyang, China.

Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.

出版信息

HPB (Oxford). 2020 Apr;22(4):578-587. doi: 10.1016/j.hpb.2019.08.003. Epub 2019 Aug 27.

DOI:10.1016/j.hpb.2019.08.003

PMID:31471064

Abstract

BACKGROUND

Biliary reconstruction in ex vivo liver resection followed by autotransplantation (ERAT) for end-stage hepatic alveolar echinococcosis (HAE) remains the most challenging step, we present our experience with this complex procedure.

METHODS

A retrospective data analysis of 55 patients with end-stage HAE underwent ERAT, the biliary reconstruction techniques and short- and long-term outcomes were discussed.

RESULTS

All autografts were derived from the left lateral section after extensive ex vivo liver resection, multiple bile ducts were observed in 52 (94.5%) patients, and forty-four (80.0%) cases required ductoplasty. Biliary reconstruction was achieved with duct-to-duct anastomosis in 32 (58.2%) patients, Roux-en-Y hepaticojejunostomy (RYHJ) in 14 (25.5%) patients, and a combination of the two methods in 9 (16.4%) patients. Twenty (36.4%) patients had multiple anastomoses. Biliary leakage occurred in 8 (14.5%) patients postoperatively. Three (5.5%) patients died of liver failure, cerebral hemorrhage and intraabdominal bleeding. During a median of 31 months followed-up time, 3 (5.5%) patients developed anastomotic stricture, 1 of whom was treated by repeat RYHJ, while the others were managed with stenting.

CONCLUSIONS

With a well-designed plan and precise anastomosis, complex biliary reconstruction in ERAT can be performed with few biliary complications by a professional team.

摘要

背景

在体外肝切除和自体肝移植（ERAT）治疗终末期肝泡型包虫病（HAE）中，胆道重建仍然是最具挑战性的步骤，我们介绍了我们在这一复杂手术中的经验。

方法

回顾性分析了 55 例接受 ERAT 治疗的终末期 HAE 患者的资料，讨论了胆道重建技术和短期及长期结果。

结果

所有自体移植物均来自广泛体外肝切除后的左外侧叶，52 例（94.5%）患者观察到多个胆管，44 例（80.0%）需要胆管成形术。32 例（58.2%）患者采用胆管对胆管吻合术，14 例（25.5%）患者采用 Roux-en-Y 胆肠吻合术（RYHJ），9 例（16.4%）患者采用两种方法联合。20 例（36.4%）患者有多个吻合口。术后 8 例（14.5%）患者发生胆漏。3 例（5.5%）患者死于肝功能衰竭、脑出血和腹腔内出血。在中位数为 31 个月的随访期间，3 例（5.5%）患者发生吻合口狭窄，其中 1 例患者接受了重复 RYHJ 治疗，其余患者接受了支架治疗。