Tay Vivyan W Y, Wang Zhongkai, Goh Brian K P
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital; Duke-National University of Singapore Medical School, Singapore.
J Minim Access Surg. 2020 Oct-Dec;16(4):431-434. doi: 10.4103/jmas.JMAS_295_19.
Experience with complex robotic-assisted laparoscopic (RAL) hepatobiliary and pancreatic (HPB) surgery remains limited to few tertiary institutions worldwide. In this report, we focus on biliary bypass surgery, one of the more complex HPB surgeries. Over the past few decades, the laparoscopic approach has gained preference over the open approach, but the robotic approach is still uncommon. Biliary bypass is also not often performed in nonagenarians due to its inherent-associated morbidity and mortality, and these patients typically have higher surgical risks. We present two cases of nonagenarians who had recurrent episodes of cholangitis secondary to multiple primary common bile duct (CBD) stones and ectatic bile ducts. Both the patients were treated conservatively over many years with repeated endoscopic retrograde cholangiopancreatography and stentings. They eventually presented to us and underwent successful RAL CBD exploration with hepaticojejunostomy.
复杂的机器人辅助腹腔镜（RAL）肝胆胰（HPB）手术的经验在全球范围内仍仅限于少数几家三级医疗机构。在本报告中，我们重点关注胆道搭桥手术，这是较为复杂的HPB手术之一。在过去几十年中，腹腔镜手术方式已比开放手术方式更受青睐，但机器人手术方式仍然不常见。由于其固有的相关发病率和死亡率，百岁老人中也不常进行胆道搭桥手术，而且这些患者通常手术风险更高。我们报告两例百岁老人病例，他们因多发原发性胆总管（CBD）结石和胆管扩张继发胆管炎反复发作。多年来，这两名患者均通过反复的内镜逆行胰胆管造影术和支架置入术进行保守治疗。他们最终前来我院就诊，并成功接受了RAL胆总管探查并肝空肠吻合术。
