A novel combined interventional radiologic and hepatobiliary surgical approach to a complex traumatic hilar biliary stricture.
A novel combined interventional radiologic and hepatobiliary surgical approach to a complex traumatic hilar biliary stricture.
复制标题
一种新颖的联合介入放射学和肝胆外科手术方法治疗复杂的创伤性肝门部胆道狭窄。
DOI：
10.1016/j.ijscr.2018.02.043
复制
发表时间：
2018
影响因子：
0.6
通讯作者：
Carpizo,DarrenR
中科院分区：
文献类型：
--
作者：
NeMoyer,RachelE;Shah,MihirM;Hasan,Omar;Nosher,JohnL;Carpizo,DarrenR
IntroductionBenign狭窄的胆道系统是具有挑战性的和罕见的情况下，需要一个多学科的团队进行适当的management.Presentation的情况下，病人是一个32岁的男性，开发了肝门狭窄的后遗症枪伤。由于肝门狭窄和瘢痕形成的复杂性，进行了联合介入放射学和手术方法，以接近右肝管和左肝管的门。术中使用球囊头端导管在术中超声引导下发现狭窄的位置，该导管在手术前置于介入放射室的荧光透视下。这使得外科医生能够选择最佳狭窄可视化的实质横切线。进行左肝切除术，内部支架定位和右肝管切向打开，以允许侧到侧Roux-en-Y hepaticojejunostomy（Puestow样吻合术）。DiscussionInjury的肝内胆管汇合很少是致命的，然而，相关的损伤导致严重的发病率，如本例所示。这些损伤的管理构成了相当大的挑战，外科医生和治疗physics.ConclusionHere我们描述了一种创新的多学科的方法来修复这种罕见的损伤。
IntroductionBenign strictures of the biliary system are challenging and uncommon conditions requiring a multidisciplinary team for appropriate management.Presentation of caseThe patient is a 32-year-old male that developed a hilar stricture as sequelae of a gunshot wound. Due to the complex nature of the stricture and scarring at the porta hepatis a combined interventional radiologic and surgical approach was carried out to approach the hilum of the right and left hepatic ducts. The location of this stricture was found by ultrasound guidance intraoperatively using a balloon tipped catheter placed under fluoroscopy in the interventional radiology suite prior to surgery. This allowed the surgeons to select the line of parenchymal transection for best visualization of the stricture. A left hepatectomy was performed, the internal stent located and the right hepatic duct opened tangentially to allow a side-to-side Roux-en-Y hepaticojejunostomy (a Puestow-like anastomosis).DiscussionInjury to the intrahepatic biliary ductal confluence is rarely fatal, however, the associated injuries lead to severe morbidity as seen in this example. Management of these injuries poses a considerable challenge to the surgeon and treating physicians.ConclusionHere we describe an innovative multi-disciplinary approach to the repair of this rare injury.