Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni 56, 20089, Rozzano, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy.
Updates Surg. 2021 Oct;73(5):2017-2022. doi: 10.1007/s13304-021-00987-8. Epub 2021 Mar 25.
Roux-en-Y hepaticojejunostomy (HJ) is the standard of care for biliary reconstruction. Its weaknesses are the loss of the sphincter functionality, which could lead to repeated cholangitis, and the reduced endoscopic accessibility to the biliary tree. In the context of liver transplantation it has been shown that duct-to-duct biliary anastomosis may be suitable as an alternative to HJ, significantly reducing the risk of cholangitis. Here we present our experience on stent-free duct-to-duct reconstruction, performed in six patients receiving hepatectomy with resection of the biliary confluence. Operative mortality was nil. Anastomotic leak occurred in four patients and resolved spontaneously in all cases. One patient developed anastomotic stricture 17 months after surgery and only one patient developed tumor recurrence at the anastomotic site; in both cases the endoscopic stenting succeeded in restoring the ducts patency. With a median follow-up of 24 months (range 19-28 months), no cholangitis or other biliary-related complications were observed. Our experience, although limited, shows satisfactory oncological and functional outcomes, confirming all previously published results.
Roux-en-Y 肝肠吻合术 (HJ) 是胆道重建的标准治疗方法。其缺点是丧失了括约肌功能，这可能导致反复胆管炎，并且内镜对胆道的可及性降低。在肝移植的背景下，已经表明胆管对胆管吻合术可能适合作为 HJ 的替代方法，显著降低胆管炎的风险。在这里，我们介绍了我们在六例接受肝切除术和胆管汇合部切除的患者中进行的无支架胆管对胆管重建的经验。手术死亡率为零。吻合口漏发生在 4 例患者中，所有病例均自发缓解。1 例患者术后 17 个月出现吻合口狭窄，仅 1 例患者在吻合部位复发肿瘤；在这两种情况下，内镜支架都成功地恢复了胆管通畅。中位随访时间为 24 个月（范围 19-28 个月），未观察到胆管炎或其他与胆道相关的并发症。我们的经验虽然有限，但显示出满意的肿瘤学和功能结果，证实了所有先前发表的结果。
