Ohtsuka T, Chijiiwa K, Yamaguchi K, Akashi Y, Matsunaga H, Miyoshi A
Department of Surgery, Chihaya Hospital, Fukuoka, Japan.
JSLS. 1999 Oct-Dec;3(4):323-6.
A case of bile duct injury during laparoscopic cholecystectomy finally necessitating right hepatic lobectomy is reported to re-emphasize the importance of preoperative and intraoperative assessment of the biliary tree. A 47-year-old Japanese woman underwent laparoscopic cholecystectomy for cholecystolithiasis. On postoperative day 5, fever and right hypochondralgia developed, and CT revealed fluid collection at the right hypochondrium. Percutaneous drainage was performed, and subsequent fistulography revealed a communication of the cystic cavity with the right posterior bile duct, which suggested injury of the aberrant hepatic duct. Conservative therapy, including the adaptation of fibrin glue, was performed, but closure of the fistula and cavity was not obtainable. Finally, a right hepatic lobectomy was performed four months after cholecystectomy. In this case, endoscopic retrograde cholangiopancreatography was unsuccessful preoperatively, and intraoperative cholangiography was not done. This case report re-emphasizes that the preoperative and intraoperative examination of the biliary tree is mandatory to avoid bile duct injury.
本文报告了一例腹腔镜胆囊切除术中胆管损伤最终需要进行右肝叶切除术的病例，以再次强调术前和术中评估胆管树的重要性。一名47岁的日本女性因胆囊结石接受了腹腔镜胆囊切除术。术后第5天，出现发热和右季肋部疼痛，CT显示右季肋部有液体积聚。进行了经皮引流，随后的瘘管造影显示胆囊腔与右后胆管相通，提示肝迷走胆管损伤。采取了包括使用纤维蛋白胶在内的保守治疗，但瘘管和腔隙未能闭合。最终，在胆囊切除术后四个月进行了右肝叶切除术。在该病例中，术前内镜逆行胰胆管造影未成功，术中也未进行胆管造影。本病例报告再次强调，为避免胆管损伤，术前和术中对胆管树进行检查是必不可少的。
