Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China.
Department of Burn and Plastic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042, China.
BMC Surg. 2024 Apr 10;24(1):102. doi: 10.1186/s12893-024-02393-4.
Radical resection is the most effective treatment for perihilar tumors. Biliary tract reconstruction after resection is one of the key steps in this surgery. Mucosa-to-mucosa cholangiojejunostomy is traditionally performed, in which the bile ducts at the resection margin are separately anastomosed to the jejunum. However, this approach is associated with long operative time and high risk of postoperative complications. The present study presents a modified technique of hepatojejunostomy and its outcomes.
The data of patients who underwent hepatojejunostomy using the modified technique at the Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, China, from January 2016 to December 2021, were retrospectively analyzed.
A total of 13 patients with perihilar tumors underwent R0 resection and bilioenteric reconstruction using the modified hepatojejunostomy technique during the study period. During the operation, the alignment of the bile duct stumps was improved, the posterior wall of the anastomosis was reinforced, internal stents were placed in the smaller bile ducts, external stents were placed in the larger bile ducts, and hepatojejunostomy was performed using 4 - 0 prolene. No serious postoperative complications, such as death or bile leakage, occurred during the hospitalization. Furthermore, there were no cases of biliary stricture or cholangitis after the six-month follow-up period.
The modified hepatojejunostomy technique is a safe and effective technique of biliary reconstruction after the resection of perihilar tumors. This can be easily performed for difficult cases with multiple bile ducts that require reconstruction after resection.
根治性切除术是治疗肝门部肿瘤最有效的方法。肝门部肿瘤切除后胆道重建是该手术的关键步骤之一。传统上采用黏膜对黏膜胆肠吻合术，即将切除边缘的胆管分别与空肠吻合。然而，这种方法操作时间长，术后并发症风险高。本研究介绍了一种改良的肝肠吻合术及其结果。
回顾性分析 2016 年 1 月至 2021 年 12 月在陆军军医大学大坪医院肝胆外科采用改良肝肠吻合术治疗肝门部肿瘤患者的临床资料。
研究期间，共 13 例肝门部肿瘤患者行 R0 切除及胆肠吻合术，采用改良肝肠吻合术。手术中，改善了胆管残端的对位，加固了吻合口后壁，小胆管内置入内支撑管，大胆管外置支撑管，使用 4-0 prolene 行肝肠吻合术。患者住院期间无严重术后并发症，如死亡或胆漏。此外，在 6 个月的随访期内，无胆管狭窄或胆管炎病例。
改良肝肠吻合术是肝门部肿瘤切除后胆道重建的一种安全有效的方法。对于需要重建的多发性胆管困难病例，该方法易于操作。
