Doldi S B, Marinoni M, Mozzi E, Longoni F, Zappa M A
Cattedra di Chirurgia Generale I, Universita degli Studi di Milano, Casa di Cura S. Ambrogio, Italy.
Hepatogastroenterology. 1999 May-Jun;46(27):1631-3.
Two cases of biliary tract serious lesions during videolaparoscopic cholecystectomy are reported. In the first case of lithiasic cholecystitis there had been a complete damage of the common biliary duct; in the second case there had been a double main biliary duct binding with removal of a biliary tract segment. In both cases a biliary confluence-jejunal anastomosis with Roux-en-Y loop was made up. In the first one the operation was difficult because of the main bile duct's fragility and modest expansion. In the second one the presence of a secondary biliary duct in gallbladder fossa not recognized, but drained outside with a common drainage placed during the operation prevented appearance of jaundice with dilatation of biliary ducts. It was heavily conditioned performing confluence-jejunal anastomosis with Roux-en-Y loop. The post-operative course was characterized by appearance of an external biliary fistula which has spontaneously disappeared. One year later, neither of the two patients had any stenosis or cholangitis problems.
报告了两例腹腔镜胆囊切除术期间发生的胆道严重病变。第一例为结石性胆囊炎，胆总管完全受损；第二例为双主胆管捆绑并切除一段胆道。两例均行胆肠吻合术，采用Roux-en-Y袢。第一例手术因胆总管脆弱且扩张不明显而困难。第二例胆囊窝内存在一条未被识别的副胆管，但术中放置的普通引流管将其引出体外，防止了胆管扩张导致黄疸的出现。行Roux-en-Y袢胆肠吻合术受到严重制约。术后病程表现为出现外胆瘘，后自行消失。一年后，两名患者均未出现任何狭窄或胆管炎问题。
