Brunaud L, Sebbag H, Bresler L, Tortuyaux J M, Boissel P
Department of Digestive Surgery, University of Nancy, Brabois Hospital, France.
Hepatogastroenterology. 2000 Sep-Oct;47(35):1227-9.
Thoracobiliary fistula after blunt hepatic trauma is rare. We report a case of pleurobiliary fistula after a blunt hepatic trauma leading to a left hepatic lobe laceration together with a left hepatic duct injury. The management of this traumatic lesion is discussed and related to the existing literature data. The diagnosis of traumatic thoracobiliary fistula rests upon clinical suspicion in the setting of a persistent right pleural effusion. Demonstration of the presence of bile in the pleural cavity by thoracocentesis is considered a proof of pleural biliary fistula. We think that laparotomy is an appropriate route for the treatment of pleurobiliary fistulas. However, when a bronchobiliary fistula is suspected, the patient should be treated with thoracotomy and may require pulmonary resection to remove the fistulous tracts.
钝性肝外伤后发生胸胆瘘较为罕见。我们报告一例钝性肝外伤后发生的胸膜胆瘘,该外伤导致左肝叶裂伤并伴有左肝管损伤。本文讨论了这种创伤性病变的处理方法,并与现有文献数据相关联。创伤性胸胆瘘的诊断基于在持续右胸腔积液情况下的临床怀疑。胸腔穿刺抽出液中发现胆汁被认为是胸膜胆瘘的证据。我们认为剖腹手术是治疗胸膜胆瘘的合适途径。然而,当怀疑有支气管胆瘘时,患者应接受开胸手术,可能需要进行肺切除以切除瘘管。