Nakagawa Yoichi, Uchida Hiroo, Hinoki Akinari, Shirota Chiyoe, Tainaka Takahisa, Sumida Wataru, Makita Satoshi, Yasui Akihiro, Takimoto Aitaro, Guo Yaohui
Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Rare/Intractable Cancer Analysis Research, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Hepatobiliary Pancreat Sci. 2023 Apr;30(4):473-481. doi: 10.1002/jhbp.1235. Epub 2022 Sep 11.
BACKGROUND/PURPOSE: Congenital biliary dilatation (CBD) is a disease associated with pancreaticobiliary maljunction. The most frequent postoperative complication is intrahepatic stones, which are caused by hilar bile duct stenosis (HBDS).
We retrospectively reviewed the records of patients who underwent primary surgery for CBD between 2013 and 2021. We evaluated images and videos of HBDS, the laparoscopic technique of releasing the stenosis, and its occurrence rate and compared intraoperative bile duct findings with those of preoperative magnetic resonance cholangiopancreatography (MRCP).
There were 87 CBD cases in this study. HBDS occurred in 52% and preoperative MRCP for HBDS showed a 96% sensitivity and 74% specificity in this study. Bile duct plasty was performed in 45% of the cases and videos demonstrated typical methods of laparoscopic bile duct plasty. The mid- to long-term complications were hepatolithiasis in three patients, anastomotic site stricture in three, and postoperative obstruction in two.
Our study revealed that preoperative imaging studies are useful for the prediction of HBDS. Our laparoscopic meticulous probing method for finding BDS reveals more intrahepatic BDS through magnification. Therefore, this may reduce the incidence of intrahepatic stones. Preoperative imaging and intraoperative findings can be complemented to plan management that reduces long-term complications.
背景/目的：先天性胆管扩张症（CBD）是一种与胰胆管合流异常相关的疾病。最常见的术后并发症是肝内结石，其由肝门部胆管狭窄（HBDS）引起。
我们回顾性分析了2013年至2021年间接受CBD初次手术患者的记录。我们评估了HBDS的影像和视频、解除狭窄的腹腔镜技术及其发生率，并将术中胆管发现与术前磁共振胰胆管造影（MRCP）结果进行比较。
本研究中有87例CBD病例。HBDS发生率为52%，本研究中术前MRCP对HBDS的敏感性为96%，特异性为74%。45%的病例进行了胆管成形术，视频展示了腹腔镜胆管成形术的典型方法。中长期并发症包括3例肝内结石、3例吻合口狭窄和2例术后梗阻。
我们的研究表明术前影像学检查对预测HBDS有用。我们用于发现BDS的腹腔镜精细探查方法通过放大能发现更多肝内BDS。因此，这可能降低肝内结石的发生率。术前影像学检查和术中发现可相互补充，以规划减少长期并发症的治疗方案。
