肝门胆管良性狭窄的原因和处理

目的：探讨单纯肝门胆管良性狭窄的原因和治疗。方法：回顾性总结分析单纯肝门胆管良性狭窄73例的病因,治疗方法和效果。结果：病因依次为肝胆管结石（48例）,高位胆管损伤（19例）,胆囊结石Mirizzi征（4例）,单纯良性瘢痕性狭窄（2例）,分别施行了肝门胆管空肠吻合,肝门胆管整形,肝门胆管切除等手术87例次,随访1－19年61例次的远期效果,优良77％,好转6．6％,差16．4％,其中,以肝门胆管空肠吻合效果最好,优良达90．7％,结论：肝门胆管良性狭窄的主要原因是肝胆管结石和高位胆管损伤,治疗以肝门胆管空肠大口吻合效果最好。     

Porta hepatis disruption from blunt trauma

Extrahepatic porta hepatis injuries from blunt abdominal trauma are exceedingly rare; all recently reported cases involve disruption of the common bile duct at its intrapancreatic portion. We herein report a patient with lacerations of the proper hepatic artery and bile duct occurring from deceleration/torsion of the porta hepatis after high speed vehicular collision.     

肝中央区肝肿瘤的手术切除

目的 探讨位于肝中央区肝肿瘤手术切除的安全性和可行性。方法 回顾性分析近6年经手术切除位于肝中央区的肝肿瘤36例的临床资料，其中肝癌26例，良性肿瘤10例。肿瘤累及第一肝门者13例，第二肝门10例，第三肝门5例，同时累及第一和第三肝门3例，第二和第三肝门5例。结果 全组术中并发大出血4例(11．1％)，术后发生并发症11例(30．5％)，包括肝衰竭1例(2．7％)，胆瘘2例(5．5％)，胸腔积液6例(16．7％)，膈下感染1例(2．7％)，腹壁切口疝1例(2．7％)；除1例因急性肝衰竭术后死亡外，余均恢复出院。结论 此类手术难度大、风险大．只要术前重视适应证的选择，术中妥善处理，仍可成功切除肿瘤，减少并发症的发生。     

Biliary Atresia: histopathologic observations and reflections upon its natural history

Operative liver biopsies and specimens of the extrahepatic ducts and porta hepatis have been studied in 12 cases of biliary atresia. In all cases, the liver showed giant cell transformation and inflammation with mononuclear cells and neutrophils. Most had other features of neonatal hepatitis, including necrosis of hepatocytes. In the intrahepatic bile ducts of all cases but one, the hepatic ducts and glands at the porta hepatis, and in the extrahepatic ducts where epithelium remained, there was degeneration of the epithelium and intramural inflammation. In the ducts at the porta hepatis and in 6 of 8 extrahepatic ducts where epithelium remained, there was extensive mural fibrosis compromising the diameter of the duct lumens. Three cases showed the inflammatory changes distal to sites of closure of the extrahepatic ducts. These findings demonstrate that in biliary atresia, hepatitis, intrahepatic cholangitis, and sclerosing cholangitis of the extrahepatic ducts all interact to produce acquired obstruction to bile flow.     

Histopathologic study of the extrahepatic biliary system in uncorrectable congenital biliary atresia: its pathogenesis and type of atresia

Histopathologic study was carried out on specimen of extrahepatic biliary system in 23 patients with congenital biliary atresia, and the data were compared with those obtained from a control group of 43 autopsy cases of newborns and infants. In the control cases, accessory tubulo-alveolar glands were observed around the extrahepatic bile duct, and in addition some small ductules were observed in the area of the porta hepatis. In cases of biliary atresia, characteristic findings were histologically detected at each level of the extrahepatic biliary system. In the area of the porta hepatis, there were many epithelial luminal structures in fibrous tissue with inflammatory infiltrates. Near the confluence, the bile duct completely disappeared to be replaced by fibrosis, and in the area between the porta hepatis and the confluence, granulation tissue surrounded by fibrosis was observed. The epithelial luminal structures in the area of the porta hepatis were thought to originate from the bile duct, draining ductules and accessory glands observed in the normal controls. These structures tended to decrease in number with time. In cases possessing a patent common bile duct, the gallbladder showed many mucous glands and no inflammatory changes. On the other hand, in cases with an obliterated common bile duct, the gallbladder showed chronic atrophic cholecystitis without any mucous glands. The pathogenesis remains unknown, but it is thought that this disorder results from non-infectious inflammatory changes initiated near the confluence of the normally developed bile duct.     

Caudate arterial branch bleeding: a rare complication after a Kasai portoenterostomy

Massive bleeding from the porta hepatis is a rare complication after a Kasai portoenterostomy and usually requires urgent surgical intervention. Among the causes of the porta hepatis bleeding, bleeding from the injured caudate arterial branches has never been reported. Here, we describe 2 cases of caudate arterial branch bleeding after a Kasai portoenterostomy, which were successfully treated with transcatheter arterial embolization without laparotomy.     

巨大肝脏海绵状血管瘤术中肝门的处理

肝脏海绵状血管瘤的最好治疗方法是手术切除，但对已侵犯肝门的血管瘤手术风险较大，肝门的处理是手术的最大难题。我们科自９４年２月至９７年２月共收治２１例紧贴一、二、三肝门的世故因管瘤，瘤体最大径线１２－３６ｃｍ，平均２４ｃｍ。术中先忆患侧肝动脉，然后再解剖分离肝门，在第一肝门阻下全部完整切除了瘤体，行中三叶及尾状叶切除５例，右半肝及尾状叶切除７例，在右半肝切除１例，右肝上段切除３例。右后叶切除２例，一     

肝胆管结石合并肝门部胆管狭窄的诊断和治疗

目的 总结肝胆管结石合并肝门部胆管狭窄诊治的临床经验。方法 回顾性分析l12例临床病例的定位诊断、术式选择、合并症、并发症及随访情况。结果 术前检查行B超l12例(准确率73．8％)，CT 74例(准确率86．5％)，PTC 31例(准确率93．5％)，ERCP 41例(准确率92．6％)，MRCP 28例(准确率96．4％)。全组均采取肝方叶切除，肝胆管切开取石、整形，高位胆肠吻合术进行治疗。术后并发症发生率10．75％，残石率18．7％，结石复发率为5．4％，优良率90．1％。结论 (1)，MRCP是肝胆管结石合并肝门部胆管狭窄术前定位诊断的最佳方法。(2)肝方叶切除是治疗肝胆管结石合并肝门部胆管狭窄的有效手段。(3)重视肝门部狭窄胆管的处理是提高疗效的关键。     

Management of injuries to the porta hepatis.

The management of injuries to the porta hepatis is challenging and controversial. Although definitive, anatomic reconstruction of injured ductal or vascular structures is optimal, porta hepatis injuries are universally accompanied by injuries to other organs (3.6 in this series), which often precludes initial repair. Moreover, frequent injury to the inferior vena cava, aorta, or other major blood vessels in addition to the structures of the porta hepatis results in these injuries being treated in conjunction with exsanguinating hemorrhage. For that reason, control of hemorrhage is the initial management priority, with the initial operation requiring expeditious, if less than anatomically exact, operations. Eighteen of 31 patients survived porta hepatis injury. Hepatic artery injuries were treated by ligation. Complex injuries to bile ducts frequently required enteric-ductal anastomoses as secondary procedures. Of 29 patients with portal vein injuries, six were treated by ligation, 22 by lateral repair, and one with splenic vein interposition graft. As in earlier reports, the structure of the porta hepatis associated with the highest morbidity and mortality rates when injured was the portal vein.     

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??Surgical treatment of giant cavernous hemangioma of the liver closely attached to porta hepatis: an analysis of 51 cases XU Feng??DAI Chao-liu??JIA Chang-jun??et al. Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004??China Corresponding author:DAI Chao-liu, E-mail:daicl-sy@tom.com Abstract Objective To analyze the surgical treatment for giant cavernous hemangima of the liver closely attached to porta hepatis. Methods The clinical data of 51 cases of giant hepatic cavernous hemangioma closely attached to porta hepatis performed surgical treatment between March 1997 and October 2007at Shengjing Hospital of China Medical University were analyzed retrospectively. Results Enucleation procedure was performed in 29 cases. Liver resection was performed in 19 cases. Suture and ligation was performed in 3 cases. The mean blood loss during intraoperative period was (1085±1539) mL, and complications occurred in 22 cases. There was no mortality. Conclusion Surgical management is safe and feasible for cavernous hemangioma of the liver. It recommend enucleation as the surgical procedure of choice for the treatment of hepatic hemangiomas. Limited to a half or caudate lobe of the liver cases can be performed hemihepatectomy or caudate lobe resection respectively.     

紧邻肝门巨大肝海绵状血管瘤51例手术治疗体会

目的 探讨紧邻肝门的巨大肝海绵状血管瘤的手术治疗。方法 回顾性分析中国医科大学附属盛京医院1997年3月至2007年10月手术治疗的51例紧邻肝门的巨大肝海绵状血管瘤的临床资料。结果 血管瘤包膜外剥除29例,肝切除19例,缝扎3例。术中平均失血量（1085±1539） mL,22例出现不同程度并发症,全组无手术死亡。结论 手术治疗紧邻肝门的巨大肝海绵状血管瘤是安全的、切实可行的,方法首选血管瘤包膜外剥除术。对限于半肝或尾状叶的病例可分别采用半肝或尾状叶切除。     

Traumatic injuries to the porta hepatis: case report and review of the literature

Injuries to the porta hepatis present a rare but life-threatening condition. This report documents a patient surviving injuries to all three structures in the porta hepatis. A literature study sets out the guidelines for the optimal treatment of these lesions.     

儿童门静脉海绵样变间接门静脉造影特点

目的探讨儿童门静脉海绵样变(CTPV)的间接门脉造影表现及其临床意义。方法回顾性分析了8例经超声诊断及造影证实的门静脉海绵样变患儿的间接门脉造影血管造影图像,观察其特征性的血管造影表现,并对其指导临床治疗的意义进行了评价。结果8例中6例清楚显示门脉主要分支近肝门处阻塞,2例门静脉主干阻塞,代之以肿块样纡曲血管并在其周围形成向肝内放射状的侧支血管影像,以及离肝性侧支循环静脉。8例血管造影均能对与分流或断流手术有关的血管解剖提供准确信息。结论儿童CTPV具有特征性的血管造影表现,间接门脉造影对CTPV的诊断和治疗有重要价值。     

胆管癌栓内镜治疗后阻塞性黄疸原因分析及处理

目的: 探讨HCC合并胆管癌栓内镜治疗后阻塞性黄疸的原因及其处理.方法: 对1999年1月至2003年6月间收治的23例采用内镜介入治疗的HCC合并胆管癌栓的患者进行跟踪随访,对其中18例患者在内镜治疗后加重或再度出现阻塞性黄疸的原因进行回顾性分析.结果: 本组术后黄疸的发生率为78.3%(18/23),原因为胆道出血16.7%(3/18)、胆管癌栓未得到有效清除44.4%(8/18)、肝门部胆管恶性狭窄27.8%(5/18)、胆管癌栓合并肝门部胆管恶性狭窄11.1%(2/18),内置管堵塞移位50%(9/18).结论: 胆管癌栓内镜治疗后阻塞性黄疸原因以内置管堵塞移位、胆管癌栓未得到有效清除和(或)合并肝门部胆管恶性狭窄最为常见,内镜治疗后早期阻塞性黄疸加重为胆道出血所至,及时对应处理可有效解除症状.     

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??Hepatic cavernous hemangioma??an analysis of 172 cases FU Xiao-hui, CHU Kai-jian, LU Chong-de, et al. Department of Comprehensive Therapy of Tumor, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 200438, China Corresponding author:YAO Xiao-ping, E-mail: yaoxiaopingehbh@163.com Abstract Objective To explore the feasibility of operation on hepatic cavernous hemangioma. Methods The clinical data of 172 patients with hepatic cavernous hemangioma performed from 2004 to 2006 at Eastern Hepatobiliary Surgery Hospital of Second Military Medical University were analyzed retrospectively. Among them, 128 patients with hemangioma involved porta hepatis. Clinical manifestation, operation and postoperative recovery were analyzed. Results Enucleation of hemangioma involving porta hepatis had more intraoperative bleeding, longer time of inflow exclusion, and higher incidence of postoperative pleural fluid, while no significant difference exists in the complication of operation and postoperative recovery. Conclusion Surgery of hemangioma involving porta hepatis is safe and effective. For patients with symptoms or young patients with rapidly enlarging mass, the enucleation of the tumor is needed and feasible. It should be carried out strictly in accordance with the rules of the liver surgery and the characteristics of the hemangioma so as to ensure the safety of the operation.     

A histopathological study of the remnant of extrahepatic bile duct in so-called uncorrectable biliary atresia

Histopathological study of the remnant of extrahepatic bile ducts in 40 cases of so-called uncorrectable biliary atresia, upon which we operated the last three years, has been performed. The histological findings of the remnant were classified into three types.Only two cases were found to have type 1a ducts in the porta hepatis area, from which we can expect better prognosis postoperatively. We also found that as the patients become older, the size of the duct in the remnant becomes smaller and the hepatic fibrosis becomes more remarkable. Therefore the operation should be performed in the infant with this lesion as young as possible.As for the evaluation of operative results of hepatic portoenterostomy for this lesion, a proper evaluation can be made only in those cases in which a microscopic examination of the remnant of extrahepatic bile duct at the porta hepatis area has been adequately performed.Concerning the pathogenesis of biliary atresia, we presume that congenital abnormalities of bile ducts are a basic factor, and additional nonspecific inflammation and bile stasis complete its pathological condition.     

Revision of porto-enterostomy in congenital biliary atresia

For the patients with insufficient bile flow following porto-enterostomy for congenital biliary atresia, removal or resection of granulation or scar tissue at the porta hepatis has been performed. Of 11 reoperations, constant bile excretion was obtained in four. Sufficient resection of scar tissue at the porta hepatis was most important for revision of porto-enterostomy. For resection of scar tissue, a special scissors devised by us was used.     

Biliary tract duplication accompanied by choledocholithiasis: Report of a case

Duplication of the biliary tract is extremely rare. In fact, to the best of our knowledge, only four previous reports of pediatric patients with this disease have been documented in the Japanese literature. This anomaly was diagnosed by perioperative endoscopic retrograde cholangiopancreatography (ERCP) in three of these patients, and incidentally during surgery for congenital biliary dilation in the other one. We report herein a case of biliary tract duplication which was diagnosed by T-tube cholangiography, only in the oblique view, after cholecystectomy and choledochotomy with T-tube drainage. The patient was a 13-year-old girl who was initially diagnosed as having choledocholithiasis based on the results of preoperative and intraoperative cholangiography; however, a postoperative T-tube cholangiography revealed residual stones. At this point, duplication of the biliary tract was diagnosed only in the first oblique view. Reoperation was carried out 26 days after the first operation. The biliary tract was dissected completely from the pancreaticobiliary junction to the left and right hepatic ducts in the porta hepatis and found to be duplicated from the level of porta hepatis to the suprapancreatic area. We report our experience of this case, followed by a discussion on the relevant literature.     

Portal hypertension complicating abdominal tuberculosis. Case report

Two cases of abdominal tuberculosis complicated by portal hypertension are reported. Both presented with haematemesis, melaena, night sweats, anorexia and weight loss. Tuberculous lymph nodes at the porta hepatis compressed the portal vein in one case, and the other had disseminated tuberculosis involving the liver and spleen. The mechanism of such portal hypertension is discussed.     

肝门部格利森蒂血流阻断在解剖性肝右叶肿瘤切除术中的应用

目的 探讨肝门部格利森蒂血流阻断在解剖性肝右叶肝癌切除术中的应用.方法 回颐性分析38例肝右叶肝癌患者的临床资料,20例采用肝门部格利森带血流阻断(A组)进行解剖性肝切除;18例采用间歇性第一肝门阻断(B组)进行肝肿瘤局部切除;对2组术中出血、术后肝功能及胆瘘情况进行比较.结果 2组病例均无死亡病例,A组无出现腹水病例...