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钝性腹部创伤中的胆囊损伤

Gallbladder injury in blunt abdominal trauma.

作者信息

Contini S, Rubini P

机构信息

Istituto di Clinica Chirurgica Generale e dei Trapianti d'organo, Università di Parma, Via Gramsci 14, 43100 Parma, Italy.

出版信息

Surg Endosc. 2001 Jul;15(7):757. doi: 10.1007/s004640042019. Epub 2001 May 14.

Abstract

A 36-year-old woman was admitted to the hospital for an abdominal blunt trauma. At ultrasound (US) and computed tomography (CT), a gallbladder lesion was suspected, along with a tear of the liver. The patient was submitted to a diagnostic laparoscopy. The gallbladder was partially avulsed and bile was infiltrated in the hepatoduodenal ligament. Intraoperative cholangiography and Kocher's maneuver excluded other lesions. Laparoscopic cholecystectomy was performed, but due to severe hemorrhage from the liver tear, the operation was converted to an open procedure. Gallbladder lesions in blunt trauma are rare occurrences, but they are often associated with other organ injuries. US and CT scan are valuable for their diagnosis, but if a lesion is suspected, diagnostic laparoscopy is advisable in stable patients. It should be accompanied by a cystic duct cholangiography and a Kocher's maneuver to evaluate the integrity of the biliary tree. Laparoscopic cholecystectomy is generally feasible. Associated lesions require laparotomy when they are not amenable to laparoscopic treatment.

摘要

一名36岁女性因腹部钝性外伤入院。超声(US)和计算机断层扫描(CT)检查怀疑有胆囊病变,同时伴有肝撕裂伤。患者接受了诊断性腹腔镜检查。胆囊部分撕脱,胆汁渗入肝十二指肠韧带。术中胆管造影和科克伦氏手法排除了其他病变。进行了腹腔镜胆囊切除术,但由于肝撕裂处严重出血,手术转为开放手术。钝性外伤中的胆囊病变很少见,但常与其他器官损伤相关。超声和CT扫描对其诊断有价值,但如果怀疑有病变,对于病情稳定的患者,建议进行诊断性腹腔镜检查。应同时进行胆囊管胆管造影和科克伦氏手法以评估胆道树的完整性。腹腔镜胆囊切除术一般可行。当相关病变不适合腹腔镜治疗时,则需要开腹手术。

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