Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Suzhou University, The First People's Hospital of Changzhou, Changzhou 213003, China.
Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Suzhou University, The First People's Hospital of Changzhou, Changzhou 213003, China.
Ann Hepatol. 2021 Mar-Apr;21:100161. doi: 10.1016/j.aohep.2019.11.004. Epub 2019 Dec 3.
In laparoscopic cholecystectomy (LC), the treatment of iatrogenic biliary tract injury has been given much attention. However, most accidental right hepatic artery (RHA) injuries are treated with simple clipping. The reason is that the RHA has difficulty in revascularization, and it is generally considered that RHA injury does not cause serious consequences. However, some studies suggest that some cases of RHA ligation can cause a series of pathological changes correlated to arterial ischemia, such as liver abscess, bile tumor, liver atrophy and anastomotic stenosis. Theoretically, RHA blood flow should be restored when possible, in order to avoid the complications of right hepatic ischemia. The present study involved two patients, including one male and one female patient. Both patients were admitted to the hospital with the diagnosis of chronic cholecystitis and gallbladder stone, and developed ischemia of the right half hepatic after accidental transection of the RHA. Both patients underwent continuous end-end anastomosis of the RHA with 6-0 Prolene suture. After the blood vessel anastomosis, the right half liver quickly recovered to its original bright red. No adverse complications were observed in follow-ups at three and six months after the operation. Laparoscopic repair of the RHA is technically feasible. Reconstruction of the RHA can prevent complications associated with right hepatic ischemia.
在腹腔镜胆囊切除术 (LC) 中，医源性胆道损伤的治疗受到了广泛关注。然而，大多数意外的右肝动脉 (RHA) 损伤通常采用单纯夹闭处理。其原因在于 RHA 难以再血管化，并且一般认为 RHA 损伤不会导致严重后果。然而，一些研究表明，RHA 结扎的一些病例可能会引起与动脉缺血相关的一系列病理变化，如肝脓肿、胆肿瘤、肝萎缩和吻合口狭窄。从理论上讲，应尽可能恢复 RHA 的血流，以避免右肝缺血的并发症。本研究涉及 2 例患者，均为男性和女性。2 例患者均因慢性胆囊炎和胆囊结石入院，在意外切断 RHA 后发生右半肝缺血。2 例患者均采用 6-0 Prolene 缝线连续端端吻合 RHA。血管吻合后，右半肝迅速恢复到原来的鲜红色。术后 3 个月和 6 个月随访均未观察到不良并发症。RHA 的腹腔镜修复在技术上是可行的。RHA 的重建可以预防与右肝缺血相关的并发症。
