双侧弥漫性肝内胆管结石伴代偿性尾状叶肥大的次全（Ⅱ-Ⅷ段）肝切除术：两例报告

Subtotal (segment II-VIII) hepatectomy for bilateral diffuse hepatolithiasis with compensatory caudate lobe hypertrophy: a report of two cases.

作者信息

Wang Wei, Zhang ZiJie, Wang Jian

机构信息

Department of Hepatobiliary and Pancreatic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.

Department of Biliary-Pancreatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.

出版信息

BMC Gastroenterol. 2020 Oct 20;20(1):350. doi: 10.1186/s12876-020-01503-9.

DOI:10.1186/s12876-020-01503-9

PMID:33081716

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7576830/

Abstract

BACKGROUND

Hepatolithiasis often leads to atrophy-hypertrophy complex due to bile duct obstruction, inflammation or infection in the affected liver segments and compensatory response in the normal segments. In severe bilateral diffuse cases, main liver can all be atrophic, leaving the caudate lobe to be extremely hypertrophic. Subtotal (segment II-VIII) hepatectomy can be an option in selected patients under such circumstances. Since rare cases have been reported, our study aims to highlight the preoperative evaluation and key points of this procedure.

CASE PRESENTATION

Two patients with primary and secondary bilateral diffuse hepatolithiasis, respectively, were enrolled in this case series. The atrophy of the left and right liver with an exceeding hypertrophy of the caudate lobe were observed. Since the liver anatomy had completely been changed, contrast computed tomography, magnetic resonance imaging combined with 3D liver reconstruction were employed for comprehensive evaluation and pre-operational planning. The patients underwent standard subtotal (segment II-VIII) hepatectomy. During operation, the hepatoduodenal ligament around porta hepatis was dissected firstly to expose the hepatic artery, portal vein, bile duct and their branches successively. And then the vessels and bile duct to caudate lobe were preserved safely through cutting off the left and right hepatic artery, portal vein and bile duct at a safe point distal to the origin of the branches to caudate lobe. Operation time was 300 min and 360 min, respectively. Blood loss was 200 ml and 300 ml. No evidence of liver dysfunction, hepatolithiasis relapse or cholangitis was observed during the follow-up of 12 and 26 months.

CONCLUSIONS

Subtotal (segment II-VIII) hepatectomy may be one of several treatments possible in selected patients with compensatory caudate lobe hypertrophy caused by bilateral diffuse hepatolithiasis.

摘要

背景

肝内胆管结石常因患侧肝段胆管梗阻、炎症或感染以及正常肝段的代偿反应而导致萎缩-肥大复合征。在严重的双侧弥漫性病例中，肝脏主体可全部萎缩，仅尾状叶极度肥大。在这种情况下，对于部分患者，次全（Ⅱ-Ⅷ段）肝切除术可作为一种选择。由于此类病例报道较少，我们的研究旨在强调该手术的术前评估及要点。

病例介绍

本病例系列纳入了两名分别患有原发性和继发性双侧弥漫性肝内胆管结石的患者。观察到左右肝叶萎缩，尾状叶极度肥大。由于肝脏解剖结构已完全改变，采用对比增强计算机断层扫描、磁共振成像结合三维肝脏重建进行综合评估及术前规划。患者接受了标准的次全（Ⅱ-Ⅷ段）肝切除术。手术过程中，首先解剖肝门周围的肝十二指肠韧带，依次暴露肝动脉、门静脉、胆管及其分支。然后在尾状叶分支起始部远端的安全点切断左右肝动脉、门静脉和胆管，从而安全保留至尾状叶的血管和胆管。手术时间分别为300分钟和360分钟。出血量分别为200毫升和300毫升。在12个月和26个月的随访期间，未观察到肝功能障碍、肝内胆管结石复发或胆管炎的迹象。