Matsumura Naoki, Tokumura Hiromi, Yasumoto Akihiro, Sasaki Hiroyuki, Yamasaki Mitsuo, Musya Hiroaki, Fukuyama Shoji, Takahashi Kenichi, Toshima Takashi, Funayama Yuji
Department of Surgery, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai, 981-8563, Japan.
Surg Today. 2009;39(3):252-5. doi: 10.1007/s00595-008-3837-0. Epub 2009 Mar 12.
A 75-year old woman was admitted to our hospital with right upper quadrant pain, vomiting, and jaundice. Laboratory findings showed elevated total bilirubin, alkaline phosphatase, gamma-glutamyl transpeptidase, and C-reactive protein levels. Abdominal ultrasonography (US) and drip infusion cholangiographic computed tomography (DIC-CT) showed not only cholecystocholedocholithiasis, but a gallbladder located left of the round ligament and close to the lateral segments of the liver. We performed laparoscopic cholecystectomy (LC) with choledocholithotomy for suspected cholecystocholedocholithiasis with a left-sided gallbladder. Routine ports were inserted in the American configuration for LC. The gallbladder was normogradely separated from the gallbladder fossa, and the fundus of the gallbladder was lifted ventrally and toward to the patient's right shoulder. These procedures provided the usual view for laparoscopic choledochotomy. The patient recovered uneventfully and was discharged on postoperative day 10. To our knowledge, this is the first report of laparoscopic common bile exploration in a patient with a left-sided gallbladder.
一名75岁女性因右上腹疼痛、呕吐和黄疸入院。实验室检查结果显示总胆红素、碱性磷酸酶、γ-谷氨酰转肽酶和C反应蛋白水平升高。腹部超声(US)和滴注式胆管造影计算机断层扫描(DIC-CT)不仅显示胆囊胆总管结石,还显示胆囊位于圆韧带左侧且靠近肝脏外侧段。我们对疑似胆囊胆总管结石伴左侧胆囊的患者进行了腹腔镜胆囊切除术(LC)及胆总管切开取石术。按照美国式布局常规插入LC手术端口。胆囊从胆囊窝正常分离,胆囊底部向腹侧并朝着患者右肩提起。这些操作提供了腹腔镜胆总管切开术的常规视野。患者恢复顺利,术后第10天出院。据我们所知,这是关于左侧胆囊患者腹腔镜胆总管探查的首例报告。