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基于双标志物引导的病变胆管树区域腹腔镜肝切除术治疗肝内胆管结石：病例报告

Laparoscopic hepatectomy based on diseased bile duct tree territory guided by double landmarks for hepatolithiasis: A case report.

作者信息

Yang Yue-Hua, Li Xiao-Ju, Liu Yi-Xuan, Wang Xing-Ru, Li Jian-Wei

机构信息

Institute of Hepatobiliary Surgery of the Army, Southwest Hospital, Army Medical University, Chongqing 400038, China.

Department of Hepatobiliary Surgery, Qujing Second People's Hospital of Yunnan Province, Qujing 655000, Yunnan Province, China.

出版信息

World J Gastrointest Surg. 2025 Aug 27;17(8):108959. doi: 10.4240/wjgs.v17.i8.108959.

DOI:10.4240/wjgs.v17.i8.108959
PMID:40949374
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12427032/
Abstract

BACKGROUND

Complex hepatolithiasis has a high perioperative risk and recurrence rate. Currently, standardized treatment protocols and reliable anatomical landmarks remain undefined, posing considerable challenges for laparoscopic hepatectomy in these cases. Achieving complete stone clearance and addressing hilar bile duct stenosis are critical determinants of surgical efficacy in hepatolithiasis management.

CASE SUMMARY

We present the case of a woman with intrahepatic and extrahepatic bile duct stones and chronic cholangitis who underwent laparoscopic hepatectomy. Hepatic segments I, II, III, IV, VI, and VII of the diseased bile duct tree and bile duct cyst were resected according to the preoperative plan, plastic repair of the hilar bile duct was performed, and the repaired bile duct was anastomosed with the jejunum. The patient achieved a favorable prognosis and long-term survival.

CONCLUSION

Based on segmental/subsegmental diseased bile duct tree territory hepatectomy and hilar stenosis relief, laparoscopic hepatectomy for complex hepatolithiasis can be safely performed guided by double landmarks (diseased bile duct/hepatic vein).

摘要

背景

复杂肝内胆管结石的围手术期风险和复发率较高。目前，标准化治疗方案和可靠的解剖标志尚不明确，给此类病例的腹腔镜肝切除术带来了巨大挑战。实现结石完全清除和解决肝门部胆管狭窄是肝内胆管结石治疗中手术疗效的关键决定因素。

病例摘要

我们报告一例患有肝内和肝外胆管结石及慢性胆管炎的女性患者接受腹腔镜肝切除术的病例。根据术前计划切除病变胆管树的肝段Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅵ和Ⅶ以及胆管囊肿，对肝门部胆管进行整形修复，并将修复后的胆管与空肠吻合。患者预后良好，长期存活。

结论

基于肝段/亚肝段病变胆管树区域肝切除术及肝门部狭窄解除，在双标志（病变胆管/肝静脉）引导下可安全地进行复杂肝内胆管结石的腹腔镜肝切除术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c452/12427032/378814d06a9c/wjgs-17-8-108959-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c452/12427032/84259c98e3e5/wjgs-17-8-108959-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c452/12427032/fd2879cb474d/wjgs-17-8-108959-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c452/12427032/b185bfe82183/wjgs-17-8-108959-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c452/12427032/431eca6c6bfe/wjgs-17-8-108959-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c452/12427032/a31764e8a58b/wjgs-17-8-108959-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c452/12427032/378814d06a9c/wjgs-17-8-108959-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c452/12427032/84259c98e3e5/wjgs-17-8-108959-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c452/12427032/fd2879cb474d/wjgs-17-8-108959-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c452/12427032/b185bfe82183/wjgs-17-8-108959-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c452/12427032/431eca6c6bfe/wjgs-17-8-108959-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c452/12427032/a31764e8a58b/wjgs-17-8-108959-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c452/12427032/378814d06a9c/wjgs-17-8-108959-g006.jpg

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本文引用的文献

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Surg Endosc. 2023 Jul;37(7):5737-5751. doi: 10.1007/s00464-023-10198-4. Epub 2023 Jun 20.
2
Landmarks to identify segmental borders of the liver: A review prepared for PAM-HBP expert consensus meeting 2021.肝脏节段边界的定位标志：为 PAM-HBP 专家共识会议 2021 准备的综述。
J Hepatobiliary Pancreat Sci. 2022 Jan;29(1):82-98. doi: 10.1002/jhbp.899. Epub 2021 Feb 3.
3
Glissonian approach combined with major hepatic vein first for laparoscopic anatomic hepatectomy.
Glissonian 入路联合肝静脉优先法在腹腔镜解剖性肝切除术中的应用。
Hepatobiliary Pancreat Dis Int. 2018 Aug;17(4):316-322. doi: 10.1016/j.hbpd.2018.06.002. Epub 2018 Jun 25.
4
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5
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