腹腔镜肝空肠吻合术成功治疗婴儿先天性胆道扩张伴右肝动脉和胆总管畸形。

Pub Date : 2024-02-13 eCollection Date: 2024-01-01 DOI:10.1055/s-0044-1779624
Shun Onishi, Koji Yamada, Masakazu Murakami, Toshio Harumatsu, Takafumi Kawano, Satoshi Ieiri
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引用次数: 0

摘要

一名患有先天性肾积水的男孩每个月都要接受超声波检查以进行随访。4 个月大时,超声波检查意外发现先天性胆道扩张(5 厘米 Ia 型)。我们为他实施了腹腔镜肝外胆管切除术和肝空肠吻合术。解剖扩张的胆总管(CBD)后,我们发现弧形的右肝动脉(RHA)在胆总管前方。此外,我们还在主肝管下方发现了一根细小的导管。起初,我们认为这是一条淋巴管,并将其与主肝管分开。然而,在解剖细小管道后,我们发现胆汁流出。最后,我们确认它是来自尾状区的异常胆管。我们以双管方式将尾状部的胆管与主肝管吻合,并在 RHA 下方进行了肝空肠吻合术。术后恢复顺利。超声波检查显示包括尾状叶在内的肝内导管没有扩张。
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Successful Laparoscopic Hepaticojejunostomy for Infant Congenital Biliary Dilatation with both Aberrant Right Hepatic Artery and Bile Duct from the Caudate Region.

A boy with congenital hydronephrosis underwent ultrasonography every month for follow-up. At 4 months of age, ultrasonography incidentally revealed congenital biliary dilatation (5-cm type Ia). We performed laparoscopic extrahepatic bile duct resection and hepaticojejunostomy. After dissecting the dilated common bile duct (CBD), we found that the arcading-like shaped right hepatic artery (RHA) coursed in front of the CBD. Additionally, a tiny duct was identified below the main hepatic duct. At first, we thought it was a lymphatic vessel and dissected it from the main hepatic duct. However, bile flow out was recognized after dissecting the tiny duct. Finally, we confirmed it as an aberrant bile duct from the caudate region. We anastomosed the bile duct from the caudate region and main hepatic duct in a double-barrel fashion and performed hepaticojejunostomy below the RHA. The postoperative course was uneventful. Ultrasonography showed no intrahepatic ductal dilatation including the caudate lobe.

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