Intrahepatic Repair of Bile Duct Injuries. A Comparative Study

Introduction The frequency of bile duct injuries associated to cholecystectomy remains constant (0.3–0.6%). A multidisciplinary approach (endoscopical, radiological, and surgical) is necessary to optimize the outcome of the patient. Surgery is indicated when complete section of the duct is identified (Strasberg’s E injuries) requiring a bilioenteric anastomosis as treatment. Nowadays, the most frequent technique used for reconstruction is a Roux-en-Y hepatojejunostomy. Long-term results of reconstruction are related to several technical and anatomic factors, but an ischemic duct (with subsequent scarring) plays a mayor role. In this paper, we report the results of biliary reconstructions comparing the extrahepatic—probably ischemic—to intrahepatic—non ischemic—repairs. Methods We reviewed the files of patients referred to our hospital (third-level teaching hospital) for bile duct repair after iatrogenic injury from 1990 to July 2006. Injury classification, time lapse since injury, surgical repair technique, and long-term follow-up were noted. In all cases, a Roux-en-Y hepatojejunostomy was done. Partial resection of segment IV was performed in 136 patients to obtain noninflamed, nonscarred, nonischemic biliary ducts with the purpose of reaching the confluence and achieving a high-quality bilioenteric anastomosis. An anastomosis at the level of the confluence was attempted in 293 patients (in 198 the confluence was preserved and in 95 it was lost). In the remaining 80 patients, a low bilioenteric anastomosis was done at the level of the common hepatic duct. We compared intrahepatic (198) and extrahepatic (80) repairs. Results A total of 405 cases (88 males, 317 females) were identified, with a mean age of 42 years (range 17–75). All of the injuries were classified as Strasberg E1, E2, E3, E5 (less frequent); those with E4 classification (separated ducts) were excluded. In all cases, the confluence was preserved (N = 293). Thirty-two cases were repaired minutes to hours after the injury occurred. The remaining 373 patients arrived weeks after the injury. In 198 cases, an intrahepatic repair was done, including the 136 in which resection of segments IV and V was part of the surgery. In the remaining 80 cases (operated between 1990 and 1997), an extrahepatic repair was done at the level of the common hepatic duct where the surgeon found a healthy duct. Twelve (15%) of the 80 cases with extrahepatic anastomosis required a new intervention (surgical or radiological), compared to only 8 of the 198 (3%) that had an intrahepatic anastomosis (P = 0.00062). Good results were obtained in 85% and 97% of the cases with extrahepatic anastomosis and intrahepatic anastomosis, respectively. Both groups had a reintervention rate of 7% (20/278). Conclusions An intrahepatic anastomosis requires finding nonscarred, nonischemic ducts, thus allowing a safe and high-quality anastomosis with significantly better results when compared to the low-level anastomosis group.     

Operative repair of bile duct injuries involving the hepatic duct confluence.

Injuries at the hepatic duct confluence present the surgeon with a technically demanding repair, often combined with life-threatening sequelae such as sepsis and portal hypertension. Moreover, the possibility of litigation is ever present, even for those not responsible for the initial injury. In this review, we discuss the approach to patients with proximal bile duct injuries, with emphasis on preoperative evaluation and the technical aspects of biliary reconstruction.     

Surgical Treatment for Biliary Carcinoma Arising After Pancreatoduodenectomy

The clinicopathological features and surgical treatment of biliary carcinoma around the major hepatic duct confluence arising after pancreatoduodenectomy (PD) due to initial bile duct carcinoma are described in three patients. Occurrence of biliary carcinoma more than 12 years after initial surgery and a histological finding of cholangiocellular carcinoma mixed with hepatocellular carcinoma suggested metachronous incidence of biliary carcinoma after PD. Extended right hemihepatectomy with complete removal of the residual extrahepatic bile duct and segmental, resection of the jejunal loop were carried out safely without operative death or severe postoperative complications. Two patients died of tumor recurrence 6 months after surgery, and the remaining patient is currently living a normal life without evidence of recurrence 17 months after surgery. These surgical procedures are a therapeutic option in patients with biliary carcinoma around the major hepatic duct confluence arising after PD.     

Long-term evaluation of biliary reconstruction after partial resection of segments IV and V in iatrogenic injuries

Roux-en-Y hepatojejunostomy is the procedure of choice for biliary reconstruction after complex iatrogenic injury that is usually associated with vascular injuries and concomitant ischemia of the ducts. To avoid the ischemic component, our group routinely performs a high repair to assure an anastomosis in noninflamed, nonscarred, and nonischemic ducts. If the duct bifurcation is preserved, the Hepp-Couinaud approach for reconstruction is an excellent choice. Partial liver resection of segments IV and V allows adequate exposure of the bile duct at its bifurcation with an anterior approach of the ducts (therefore not jeopardizing the circulation), allowing a high quality anastomosis. Long-term results of bile duct reconstruction using this approach are described. Two hundred eighty-five bile duct reconstructions were done between 1989 and 2004 in a tertiary care university hospital. The first partial-segment IV resection was done in 1994; 94 cases have been reconstructed since then using this approach. All of them had a complex injury (Strasberg E1-E5), and although in many cases the bifurcation was preserved (E1-E3), a high bilioenteric anastomosis was done to facilitate the reconstruction. In 70 cases, the bifurcation was identified, and in the 24 in which the confluence was not preserved, the right and left ducts were found except in one case. In three patients, the right duct was found unsuitable for anastomosis, and a liver resection was done. In the remaining 21, an anastomosis was done using a stent (transhepatic, transanastomotic) through the right duct. According to Lillemoe’s criteria, 86 cases had good results (91%). In four of the eight remaining patients, there was the need to operate again due to the presence of an obstruction and/or cholangitis. In the rest, radiological instrumentation was done. Four of these cases have developed secondary biliary cirrhosis, two of which have died while waiting for a liver transplant, four and six years after reconstruction. Partial segments IV and V resection allows adequate exposure of the confluence and the isolated left or right hepatic ducts. Anterior exposure of the ducts allows an anastomosis in well-preserved, nonischemic, nonscarred, or noninflamed ducts. Parenchyma removal also allows the free placement of the jejunal limb, without external compression and tension, obtaining a high quality anastomosis with excellent long-term results. Presented at the Fifth Biennial Meeting of the American Hepato-Pancreato-Biliary Association, Fort Lauderdale, Florida, April 14–17, 2005.     

Surgical anatomy of the bile ducts at the hepatic hilum as applied to living donor liver transplantation

OBJECTIVE: To evaluate anatomic variations of the biliary tree as applied to living donor liver transplantation. SUMMARY BACKGROUND DATA: Anatomic variability is the rule rather than the exception in liver surgery. However, few studies have focused on the anatomic variations of the biliary tree in living donor liver transplantation in relation to biliary reconstruction. METHODS: From November 1992 to June 2002, 165 patients underwent major hepatectomy with extrahepatic bile duct resection; right-sided hepatectomy in 110 patients and left-sided hepatectomy in 55. Confluence patterns of the intrahepatic bile ducts at the hepatic hilum in the surgical specimens were studied. RESULTS: Confluence patterns of the right intrahepatic bile ducts were classified into 7 types. The right hepatic duct was absent in 4 of the 7 types and in 29 (26%) of the 110 livers. Confluence patterns of the left intrahepatic bile ducts were classified into 4 types. The left hepatic duct was absent in 1 of the 4 types and in 1 (2%) of the 55 livers. CONCLUSIONS: In harvesting the right liver from a donor without a right hepatic duct, 2 or more bile duct stumps will be present in the plane of transection in the graft in 3 patterns based on their relation to the portal vein. Accurate knowledge of the variations in the hepatic confluence is essential for successful living donor liver transplantation.     

Anatomic variants of the biliary tree with MR Cholangiography: feasibility and surgical applications

PURPOSE: To assess the usefulness of MR Cholangiography for evaluation of anatomic variants of the biliary tree before biliary surgery. MATERIALS AND METHODS: Our study group consisted of 45 consecutive patients (29 males, 16 females; mean age 57 years), who were referred for MR evaluation of malignant (n=26) and benign (n=19) cholangiopancreatic diseases. MR Cholangiography studies were independently reviewed by two radiologists. RESULTS: Anatomic variants of the biliary tree were observed in 9 patients (20%); 6 variants involved the biliary confluence and 4 the cystic duct (one patient had both). Anatomic variants involved principally the right posterior duct: 1 (2,2%) drainage of right posterior duct into left hepatic duct; 2 (4,4%) triple confluence of right posterior duct, right anterior duct, and left hepatic duct, and 3 (6,6%) aberrant drainage of right posterior duct into common hepatic duct. Observed cystic duct anomalies included: 2 (7,44%) low insertion of the cystic duct into the common hepatic duct and 3 (11,1%) medial insertion of the cystic duct into the common hepatic duct. CONCLUSION: MR Cholangiography accurately shows anatomic variants of the biliary tree. Noninvasive preoperative evaluation of the biliary anatomy may be important for the detection of anatomic variants that may increase the complexity of hepatic surgical procedures and biliary interventions.     

Factors predicting advanced hepatic fibrosis in patients with postcholecystectomy bile duct strictures

HYPOTHESIS: Simplified evaluation based on clinical and biochemical variables might predict the degree of hepatic fibrosis in patients with postcholecystectomy bile duct strictures. DESIGN: Prospective cohort study. SETTING: Tertiary care referral and teaching hospital. PATIENTS: Sixty-four patients with postcholecystectomy bile duct strictures undergoing definitive repair. Prospectively collected information included demographics, disease-related characteristics, and serial liver function tests. Hepatic histologic features (fibrosis, cholestasis, portal inflammation, and ductular proliferation) were independently graded by 2 pathologists masked to clinical data using a previously validated scale. Patients were dichotomized into groups based on degree of hepatic fibrosis. Univariate and multivariate analyses were performed. MAIN OUTCOME MEASURE: Identification of variables that predict the presence of advanced hepatic fibrosis (grade 2-3). RESULTS: Thirty-five patients (55%) had early hepatic fibrosis (grade 0-1), and the remaining 29 (45%) had advanced fibrosis (grade 2-3). Univariate analysis demonstrated that duration of biliary obstruction, presence of portal hypertension, basal alanine aminotransferase (ALT) levels, and time to normalization of serum total bilirubin, ALT, and alkaline phosphatase levels after surgical drainage were statistically significantly associated with the presence of advanced hepatic fibrosis. However, multivariate analysis revealed that only duration of biliary obstruction (odds ratio [OR], 1.6048; P =.009), basal ALT levels (OR, 0.9634; P =.02), and time to normalization of ALT levels after surgical drainage (OR, 1.6680; P =.006) were significant predictors of advanced hepatic fibrosis. CONCLUSION: Duration of biliary obstruction, basal ALT level, and time to normalization of ALT level after surgical repair are independent predictors of advanced hepatic fibrosis (grade 2-3) in patients with postcholecystectomy bile duct strictures.     

External biliary fistulas selectively managed by endoscopic retrograde cholangiography with sphincterotomy and/or stent placement

External bile duct fistulas are inherent postoperative complications that usually appear after biliary tract surgery, traumatic bile duct injuries and liver surgery for hepatic hydatid disease or liver transplant. The management is highly individualized, while the success and long-term results of endoscopic and surgical techniques are conflicting. The study included 32 cases with external bile duct fistulas managed by endoscopic retrograde cholangiography (ERC) with sphincterotomy and/or stent placement, including "rendez-vous" procedures in 2 cases. The causes of the external fistula were represented by cholecystectomy with/without retained common bile duct stones or strictures (22 cases), cholecystectomy and drainage of a subphrenic abscess caused by severe acute pancreatitis (1 case) and surgical interventions for hepatic hydatid disease (9 cases). Due to the prospective protocol of the study we were able to apply an individualized endoscopic treatment: sphincterotomy with proper relief of the bile duct obstruction (stone extraction) or sphincterotomy with large-size (10 Fr) stent placement for large-sized bile duct defects. The results consisted in closure of the fistula in 3.5 +/- 1.7 days for the subgroup of patients with sphincterotomy alone. Among the patients with stent insertion, fistulas healed slower in 14 +/- 3.5 days. There were no complications after endoscopic treatment; however the stent could not be passed in one patient that required subsequent surgery. In conclusion, endoscopic intervention is the treatment of choice for small external biliary fistulas complicating biliary tract surgery or liver surgery for hepatic hydatid disease. When the fistula is large, the placement of a 10 Fr endoprosthesis becomes necessary, while failure of endoscopic treatment leads to surgery with hepatico-jejunal anastomosis.     

Hepatic atrophy-hypertrophy complex due to echinococcus granulosus

Obstruction of a major hepatic vein, or major portal vein, or biliary tree branch causes atrophy of the related hepatic region, and frequently, hypertrophy in the remaining liver—the atrophy-hypertrophy complex (AHC). Whether hydatid cysts can causeAHCis controversial. The records of 370 patients who underwent surgery for hepatic hydatid disease between August 1993 and July 2002 were evaluated retrospectively. Excluding six patients with previous interventions on the liver, AHC had been recorded in the operative notes of 16 patients (4.4%); for all patients, a cyst located in the right hemiliver had caused atrophy of the right hemiliver and compensatory hypertrophy of the left hemiliver. The computed tomography images of seven patients were suitable for volumetric analysis. The median (range) right and left hemiliver volumes were 334 (0-686) ml and 1084 (663-1339) ml, respectively. The median (range) cyst volume was 392 (70–1363) ml. AHC due to Echinococcus granulosus was confirmed by objective volumetric analysis. The presence of AHC should alert the surgeon to two implications. First, pericystectomy may be hazardous due to association with major vascular and biliary structures. Second, in patients with AHC, the hepatoduodenal ligament rotates around its axis; this should be considered to avoid vascular injury if a common bile duct exploration is to be performed. This work was supported by the Istanbul University Research Fund (Project No. BYP-790/17102 005).     

Obstructive jaundice caused by hydatid cyst rupture in main bile duct

Hydatid hepatic cyst rupture into bile duct is a complication of hydatid disease. The rupture is more frequent in right or left epatic duct and occasionally in common bile duct (7-9%). A 50-year old man came to emergency room owing to jaundice, fever and abdominal pain. TC show an hydatid cyst with daughter's cyst of left liver and dilatation of biliary tree. Laboratory data of significance included an increased of liver function tests (Bilirubin, Alkaline ph., SGOT, SGPT), VES and leukocytosis. The patients was surgically treated, by total pericystectomy, colecystectomy and coledocotomy with lavage o common bile duct; finally we placed one Kehr drainage and two abdominal drainage. After 15 days of postoperative hospitalization patient was discharged. The best treatment of hydatid cyst is total pericystectomy (when possible). An alternative surgical treatment is possible for the presence of communication with biliary tree. ERCP is very important for a correct diagnosis and for a complete surgical treatment.     

Surgical management and outcome of bile duct injuries following cholecystectomy: a single-center experience

Purpose  

Biliary injury is a severe complication of cholecystectomy. The Hepp–Couinaud reconstruction with the hepatic duct confluence and the left duct may offer best long-term outcome as long as the confluence remains intact (Bismuth I–III). Complex liver surgery is usually indicated in most proximal (Bismuth IV) injuries in non-cirrhotic patients. The aim of this study was to evaluate the surgical treatment and outcome of bile duct injuries managed in a referral hepatobiliary unit.     

Surgical repair after bile duct and vascular injuries during laparoscopic cholecystectomy: when and how?

Recent collective reviews have outlined when and how surgeons should treat patients with bile duct injuries after laparoscopic cholecystectomy (LC). However, little is described about other injuries combined with bile duct injuries, for example, hepatic arterial injury and secondary biliary cirrhosis. Fifteen patients with bile duct injuries following LC were referred and surgically treated from 1990 to 1998 in our institution. We report how patients with hepatic arterial injury combined with bile duct injuries during LC were treated. The present study also reports unusual complicated situations: one patient with biliary cirrhosis referred 4 years after LC, another treated with internal biliary metallic stent referred 2.5 years after LC, and another with isolated right hepatic ductal injury. Short- and long-term surgical outcomes after biliary repair were compared between simply referred patients and those with complicated history. Patients who were referred several years after LC and who were referred after primary hepaticojejunostomy were included with patients with complicated history (n= 4, group B), and the other patients were included with patients with simple history (n= 11, group A). Simultaneous right hepatic arterial occlusion was observed in 3 of these 15 patients, and arterial reconstruction was performed in 2 of the 3 patients in addition to biliary reconstruction. No postoperative complication occurred in these three patients. The patient with isolated injury of the right hepatic duct and the other with biliary cirrhosis were successfully treated with hepaticojejunostomy. The other patient treated with biliary stent underwent hepaticojejunostomy but a second operation was required because of later stenosis. Mean hospital stay was significantly longer in group B (30.3 ± 6.9 days) than in group A (18.5 ± 2.5 days, p< 0.05). Rehospitalization was more frequent in group B than in group A (p < 0.01). However, long-term outcome was successful in both groups. The present results showed that arterial reconstruction should be performed when the distal right hepatic artery can be exposed and reconstructed, and suggested that patients with bile duct injuries during LC should be immediately referred to surgical institutions in which surgeons have adequate experience of bile duct repair and hepatic arterial reconstruction.     

Endoscopic sphincterotomy in hepatic hydatid disease open to the biliary tree

Communication with the biliary tree is the most common complication of hydatid disease of the liver and up to a few years ago surgery was the only way to treat it successfully. The introduction of endoscopic sphincterotomy represented a great advance in the management of this disease. We report the results obtained with this technique in ten patients after surgical treatment of hepatic hydatid disease open to the biliary tree. The results were satisfactory in all cases, with no morbidity or mortality. Endoscopic sphincterotomy is now the first choice treatment for surgical complications of hepatic hydatid disease open to the biliary tree, as well as the drainage procedure of choice in patients with cholangitis due to hydatid disease.     

Unilateral hepatic duct obstruction

Experience with unilateral hepatic duct obstruction is limited. We reviewed 33 cases of unilateral hepatic duct obstruction from a total of 500 patients with biliary reconstruction treated between 1965 and 1984. The median age of the patients reviewed was 56 years. The most common cause of unilateral hepatic duct obstruction was operative injury (73 percent of patients). Including operations for unilateral obstruction, patients in the series underwent 131 operations related to biliary tract problems. The most common presentation (73 percent of patients) was fever and pain. Obstruction was more common in the right duct than in the left duct by a ratio of 2:1 (22 patients versus 11 patients). The three types of surgical procedures used were hepaticojejunostomy (17 patients), dilatation and drainage (13 patients), and primary hepatic resection (3 patients). Atrophic hepatic lobes resulting in rotational deformity of the portal structures were resected in six patients with combined hepatic duct and arterial injury. No operative deaths occurred, although 51.5 percent of the patients had postoperative complications. Follow-up studies ranging from 1 to 16 years demonstrated that patients who had hepaticojejunostomy required less frequent reoperation compared with those who had dilatation (36 percent versus 64 percent) and had a lower postoperative mortality rate related to biliary tract problems (7 percent versus 18 percent). We conclude that unilateral hepatic duct obstruction continues to occur most commonly because of operative injury and is best treated by hepaticojejunostomy or by resection of chronically obstructed lobes when possible.     

Portal vein resection and reconstruction prior to hepatic dissection during right hepatectomy and caudate lobectomy for hepatobiliary cancer

BACKGROUND: Hepatobiliary cancer invading the hilar bile duct often involves the portal bifurcation. Portal vein resection and reconstruction is usually performed after completion of the hepatectomy. This retrospective study assessed the safety and usefulness of portal vein reconstruction prior to hepatic dissection in right hepatectomy and caudate lobectomy plus biliary reconstruction, one of the common procedures for radical resection. METHODS: Clinical characteristics and perioperative results were compared in patients who underwent right hepatectomy and caudate lobectomy plus biliary reconstruction with (ten patients) and without (11 patients) portal reconstruction from September 1998 to March 2002. RESULTS: All ten portal vein reconstructions were completed successfully before hepatic dissection; the portal cross-clamp time ranged from 15 to 41 (median 22) min. Blood loss, blood transfusion during the operation, postoperative liver function, morbidity and length of hospital stay were similar in the two groups. No patient suffered postoperative hepatic failure or death. CONCLUSION: This study demonstrates that portal vein reconstruction does not increase the morbidity or mortality associated with right hepatectomy and caudate lobectomy with biliary reconstruction. This approach facilitates portal vein reconstruction for no-touch resection of hepatobiliary cancer invading the hilar bile duct.     

Surgical treatment of choledochal cysts

Biliary cystic disease is uncommon in Asia and very rare in Europe and the Americas. Patients with biliary cysts may present as infants, children, or adults. When patients present as adults, they are more likely to have stones in the gallbladder, common duct, or intrahepatic ducts and to present with biliary colic, acute cholecystitis, cholangitis, or gallstone pancreatitis. With increasing age at presentation, the risks of intrahepatic strictures and stones, segmented hepatic atrophy/hypertrophy, secondary biliary cirrhosis, portal hypertension, and biliary malignancy all increase significantly. Factors to be considered when performing surgery on patients with biliary cystic disease include: (1) age, (2) presenting symptoms, (3) cyst type, (4) associated biliary stones, (5) prior biliary surgery, (6) intrahepatic strictures, (7) hepatic atrophy/hypertrophy, (8) biliary cirrhosis, (9) portal hypertension, and (10) associated biliary malignancy. In general, regardless of age, presenting symptoms, biliary stones, prior surgery or other secondary problems, surgery should include cholecystectomy and excision of extrahepatic cyst(s). With respect to the distal bile duct, the surgical principle should be excision of a portion of the intrapancreatic bile duct with care to not injure the pancreatic duct or a long common channel. Resection of the pancreatic head should be reserved for patients with an established malignancy. With respect to the intrahepatic ducts, surgery should be individualized depending on whether (1) both lobes are involved, (2) strictures and stones are present, (3) cirrhosis has developed, or (4) an associated malignancy is localized or metastatic. When the liver is not cirrhotic, hepatic parenchyma should be preserved even when strictures and stones are present. If cirrhosis is advanced, hepatic transplantation may be indicated, but this sequence of events is unusual. If a malignancy has developed, oncologic principles should be followed. Whenever possible, resection of a localized tumor including adjacent hepatic parenchyma and regional lymph nodes should be performed.     

Hepatic portocholecystostomy for biliary atresia.

Four infants with biliary atresia had gross obliteration of the common hepatic duct but residual patency of the gallbladder, cystic duct and common bile duct. The patients were treated by hepatic portocholecystostomy utilizing the extant bile ducts for biliary reconstruction. Bile drainage was achieved in all four infants. There was a conspicuous absence of postoperative cholangitis. Subsequent obstruction of the distal ducts in two patients necessitated reoperation and construction of a standard biliointestinal conduit. The other two children are surviving, jaundice-free, 5 1/2 and 5 years after operation with minimal sequelae of biliary atresia. Hepatic portocholecystostomy is a feasible surgical alternative to intestinal reconstruction in patients with biliary atresia in whom the disease is limited to the proximal extrahepatic bile ducts.     

腹腔镜下左半肝切除术

肝内胆管结石是指结石位于肝内胆管。这种疾病在西方不多见而易发于东亚地区,(肝内胆管中的)结石和(或)狭窄等因素使肝内胆管反复发生化脓性感染,不仅加重胆管的狭窄和阻塞,并加重肝实质的损害,导致肝纤维化,萎缩;感染急性发作时又易发生菌血症、感染性休克、胆源性肝脓肿、胆管溃疡致胆道出血,病变晚期则可发生胆汁性肝硬化、门脉高压症等一系列严重的后果。近年来,因为左半肝较容易操作的解剖位置使得腹腔镜下左半肝切除术在肝胆外科手术中很快得到关注,研究和临床经验表明左半肝切除术用于肝胆管结石症,兼具解除肝管梗阻(结石,尤其合并存在的肝胆管狭窄)和去除化脓性感染病灶的双重效果,有效地提高了肝胆管结石的远期治疗效果。     

Surgical treatment of giant liver hydatid cysts: comparison of cystojejunostomy and partial cystectomy

Purpose

The aim of this study was to compare partial cystectomy and internal drainage of the cyst cavity with cystojejunostomy for the surgical treatment of giant hepatic hydatid cysts.

Methods

Patients who underwent any type of surgical treatment between March 2009 and May 2013 for giant hepatic hydatid cysts were retrospectively evaluated. The data collected included demographic variables, diagnostic methods, surgical procedures, morbidity and mortality rates.

Results

Twenty-eight patients who underwent surgery for giant hepatic hydatid cysts were included. There were 16 (57 %) female patients, with a mean age of 32.8 years. The diagnostic methods primarily included abdominal ultrasonography and computed tomography, which were performed in 62 % of the patients. The patients were divided into two groups with respect to the treatment modality: Group A (n = 13) treated with cystojejunostomy and Group B (n = 15) treated with partial cystectomy. The overall rate of cavity-related complications was 25 % in Group B, whereas none of the patients in Group A had a cavity-related complication during the follow-up period (p < 0.05).

Conclusion

Cystojejunostomy is an effective and safe surgical approach for the treatment of giant hepatic hydatid cysts, with a lower rate of morbidity than partial cystectomy, and thus may be the surgical treatment of choice for giant hepatic hydatid cysts.     

64层螺旋CT三维成像在消化系统疾病诊治中的临床应用价值

目的研究64层螺旋CT三维成像在肝胆胰等消化系统疾病诊断及外科治疗方面的应用价值。方法对2005年11月至2006年8月的102例肝胆胰疾病患者行64层螺旋CT扫描及后期三维成像,立体、多角度观察病灶、肝脏管道、胰胆管结构及门静脉系统的影像学特征,结合临床手术进行对比分析。结果27例门静脉高压症患者中,25例门静脉主干清晰成像,2例门静脉主干显影不全,分别为门静脉海绵样变性和门静脉主干血栓形成。27例侧支循环显示良好。34例原发性肝癌患者中,肿瘤压迫邻近血管者9例,门静脉癌栓1例,动静脉瘘1例,23例未见肿瘤侵犯邻近组织、血管。肝内外胆管结石25例,胆管癌5例,胰腺癌5例,胆道三维成像可多方位显示结石和肿瘤,以及梗阻远、近端狭窄及扩张的胆道和胰管。根据影像资料制定手术方案,门静脉高压症、原发性肝癌、胆胰疾病的手术探查与影像学诊断符合率分别为100％、97％和100％。结论64层螺旋CT三维成像能够清晰立体的显示病灶形态、肝脏管道及胰胆管结构,精确判断病灶与周围组织的关系。