胆道閉鎖症手術の工夫 : 広範囲肝門部探索および肝門部腸吻合術

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It has been emphasized in previous literature that success or failure of hepatic porto-enterostomy depends on the technique dissecting the porta hepatis. According to these reports, the portal fibrous tissue should be freed from the posterior wall of the portal vein and transected at the level of the hepatic parenchyma. Our gross and histologic studies on the liver of autopsied cases showed that intrahepatic bile ducts had disappeared for some distance from the porta hepatis in biliary atresia. They, however, had the normal relationship to other portal structures inside and outside the liver. Based on the results of these studies, a new technique of portal dissection and hepatic porto-enterostomy was described in this report; Extensive exploration was advanced along the right hepatic artery and the left portal vein laterally into the intrahepatic portal tract. A jejnunal opening was made large enough to cover completely the explored areas near the entry of portal vessels into the intrahepatic portal tract. Both lateral edges of the jejunal opening were anastomosed to the hepatic parenchyma lateral to the site where these vessels enter into the intrahepatic portal tract in order that the explored area should not be obstructed by the wall of the jejunum anastomosed. This new operation has performed in 7 patients with complete loss of jaundice in 6 patients (all patients had sufficient amount of bile drainage). The result of this operation was better than our previous result of conventional hepatic porto-enterostomy that complete loss of jaundice had been obtained only in 25.0 per cent of patients.
日本小児外科学会の論文
1984-02-20

胆道閉鎖症手術の工夫 : 広範囲肝門部探索および肝門部腸吻合術

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