Left Lateral Sectionectomy With Intrahepatic Cholangiojejunostomy for Portal Cavernoma Cholangiopathy (PCC)—A Novel Approach

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY
Yajnadatta Sarangi, Anu Behari, Somanath Malage, Ashok Kumar II, Rajneesh K. Singh
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Abstract

The development of portal cavernoma cholangiopathy (PCC) in cases of extrahepatic portal vein obstruction (EHPVO) presents significant management challenges. Strictures, stones, and extensive collaterals at the porta hepatis contribute to considerable surgical complexity. The traditional surgical approach for such patients involves a portosystemic shunt, followed by hepaticojejunostomy when indicated. In carefully selected cases, left lateral sectionectomy combined with intrahepatic cholangiojejunostomy (Longmire’s procedure) offers a viable and durable long-term solution. We present two cases where this approach was successfully employed. Both the patients had sub-hilar strictures, and a large stone burden localized to the left lateral section of the liver. Conventional hepaticojejunostomy was contraindicated due to a heavily collateralized hilum, which precluded a safe landing zone. In these two cases, left lateral sectionectomy was performed to clear the large intrahepatic stone burden, with intrahepatic cholangiojejunostomy providing effective biliary drainage while avoiding the heavily collateralized hilar and pericholedochal regions.
左侧壁切除术联合肝内胆管空肠吻合术治疗门静脉海绵瘤胆管病(PCC)——一种新方法
肝外门静脉阻塞(EHPVO)的门静脉海绵瘤胆管病(PCC)的发展提出了重大的管理挑战。肝门处的狭窄、结石和广泛的侧支使手术相当复杂。这类患者的传统手术方法包括门系统分流,然后在指征时进行肝空肠吻合术。在精心挑选的病例中,左外侧切除术联合肝内胆管空肠吻合术(Longmire的手术)提供了一个可行和持久的长期解决方案。我们提出了两个成功采用这种方法的案例。两例患者均有肝门下狭窄,肝脏左侧有大量结石。传统的肝空肠吻合术是禁忌的,因为肝门侧支严重,妨碍了安全着陆区。在这两例病例中,我们行左外侧切除术以清除肝内大块结石,肝内胆管空肠吻合术提供了有效的胆道引流,同时避免了严重侧支的肝门和胆周区域。
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来源期刊
Journal of Clinical and Experimental Hepatology
Journal of Clinical and Experimental Hepatology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.90
自引率
16.70%
发文量
537
审稿时长
64 days
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