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解剖性胆肠吻合术作为选择性病例的终极退路——历史和当前知识状况。

Anatomical biliary reconstruction as an ultimum refugium for selective cases-History and current state of knowledge.

机构信息

Laboratory of Cancer Treatment and Tissue Regeneration, Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.

Department of Surgery, University Hospital in Pilsen, Pilsen, Czech Republic.

出版信息

J Hepatobiliary Pancreat Sci. 2024 Nov;31(11):769-781. doi: 10.1002/jhbp.12067. Epub 2024 Aug 26.

Abstract

Reconstruction of extrahepatic bile ducts is a staple procedure of HPB surgery. The current standard for most cases is a nonanatomical bilioenteric reconstruction, a satisfactory option for the majority of patients. However, it cannot be used for a small number of selective cases (short bowel syndrome, severe abdominal adhesions), where an anatomical reconstruction with or without an interponate can be used. This review summarizes current knowledge about tissue and material usage for experimental and clinical anatomical bile duct reconstruction in the last 100 years. A Pubmed database was searched for published articles about anatomical extrahepatic bile duct reconstruction in experimental and clinical settings ranging from 1920 to 2022. To date, the truly optimal interponate material has not yet been found. However, evidence reveals important properties of such material, most importantly its biodegradability and neovascularization in the recipient's body. The role of internal bile duct stenting for anatomical reconstruction seems important for the outcome. Anatomical reconstruction of extrahepatic bile ducts is an uncommon but usable technique in unique cases when a nonanatomical reconstruction cannot be done. The optimal properties of interponate material for anatomical bile duct reconstruction have been more clarified, although further research is required.

摘要

肝外胆管重建是肝胆外科学的一项基本手术。目前,大多数情况下的标准术式是非解剖性胆肠重建,这对大多数患者来说是一个满意的选择。然而,对于少数选择性病例(短肠综合征、严重腹部粘连),可以采用解剖性重建,包括或不包括间置物。本文综述了过去 100 年来实验和临床解剖性胆管重建中组织和材料应用的最新知识。在 1920 年至 2022 年期间,我们在 Pubmed 数据库中搜索了关于实验和临床环境下解剖性肝外胆管重建的已发表文章。迄今为止,尚未找到真正理想的间置物材料。然而,证据揭示了此类材料的重要特性,最重要的是其在受者体内的可生物降解性和新生血管化。在解剖重建中,内置胆管支架的作用似乎对结果很重要。当无法进行非解剖性重建时,解剖性肝外胆管重建是一种罕见但可用的技术。尽管还需要进一步的研究,但用于解剖性胆管重建的间置物材料的最佳特性已经更加明确。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe24/11589400/07cd29d94c94/JHBP-31-769-g004.jpg

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