Nishio H, Kamiya J, Nagino M, Uesaka K, Kanai M, Sano T, Hiramatsu K, Nimura Y
First Department of Surgery, Nagoya University School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya 466-8550, Japan.
J Hepatobiliary Pancreat Surg. 1999;6(4):427-30. doi: 10.1007/s005340050145.
A 57-year-old woman underwent laparoscopic cholecystectomy (LC) for cholelithiasis. Continuous bile leak was observed beginning on the first postoperative day. Postoperative endoscopic retrograde cholangiography revealed bile leak through the common hepatic duct, and severe stenosis of the hepatic confluence. A total of three percutaneous transhepatic biliary drainage (PTBD) catheters were inserted to treat obstructive jaundice and cholangitis. The patient was referred to our hospital for surgery 118 days after LC. Cholangiography through the PTBD catheters demonstrated a hilar biliary obstruction. Celiac arteriography revealed obstruction of the right hepatic artery, and transarterial portography showed occlusion of the right anterior portal branch. On the basis of the cholangiographic and angiographic findings, we performed a right hepatic lobectomy with hepaticojejunostomy to resolve the bile duct obstruction and address the problem of major vascular occlusion. The patient's postoperative recovery was uneventful and she remains well 25 months after hepatectomy. We discuss a treatment strategy for bile duct injury suspected after LC, involving early investigation of the biliary tree and prompt intervention.
一名57岁女性因胆结石接受了腹腔镜胆囊切除术（LC）。术后第一天开始观察到持续胆汁漏。术后经内镜逆行胰胆管造影显示肝总管有胆汁漏，且肝汇合处严重狭窄。共插入三根经皮经肝胆道引流（PTBD）导管以治疗梗阻性黄疸和胆管炎。该患者在LC术后118天被转诊至我院接受手术。通过PTBD导管进行的胆管造影显示肝门部胆管梗阻。腹腔动脉造影显示右肝动脉梗阻，经动脉门静脉造影显示右前门静脉分支闭塞。基于胆管造影和血管造影结果，我们进行了右肝叶切除术并肝空肠吻合术，以解决胆管梗阻并处理主要血管闭塞问题。患者术后恢复顺利，肝切除术后25个月情况良好。我们讨论了LC后疑似胆管损伤的治疗策略，包括早期对胆道系统进行检查并及时干预。
