Aldumour Awad, Aseni Paolo, Alkofahi Mohmmad, Lamperti Luca, Aldumour Elias, Girotti Paolo, De Carlis Luciano-Gregorio
Department of Hepatobiliary Surgery and Liver Transplantation Unit, Niguarda Hospital, P.za Ospedale Maggiore 3, 20162 Milan, Italy.
World J Gastroenterol. 2009 May 14;15(18):2283-6. doi: 10.3748/wjg.15.2283.
Iatrogenic bile-duct injury post-laparoscopic cholecystectomy remains a major serious complication with unpredictable long-term results. We present a patient who underwent laparoscopic cholecystectomy for gallstones, in which the biliary injury was recognized intraoperatively. The surgical procedure was converted to an open one. The first surgeon repaired the injury over a T-tube without recognizing the anatomy and type of the biliary lesion, which led to an unusual biliary mal-repair. Immediately postoperatively, the abdominal drain brought a large amount of bile. A T-tube cholangiogram was performed. Despite the contrast medium leaking through the abdominal drain, the mal-repair was unrecognized. The patient was referred to our hospital for biliary leak. Ultrasound and cholangiography was repeated, which showed an unanatomical repair (right to left hepatic duct anastomosis over the T-tube), with evidence of contrast medium coming out through the abdominal drain. Eventually the patient was subjected to a definitive surgical treatment. The biliary continuity was re-established by a Roux-en-Y hepatico-jejunostomy, over transanastomotic external biliary stents. The patient is now doing well 4 years after the second surgical procedure. In reviewing the literature, we found a similar type of injury but we did not find a similar surgical mal-repair. We propose an algorithm for the treatment of early and late biliary injuries.
腹腔镜胆囊切除术后医源性胆管损伤仍然是一种严重的主要并发症，其长期结果难以预测。我们报告一例因胆结石接受腹腔镜胆囊切除术的患者，术中发现了胆管损伤。手术转为开腹手术。首位外科医生在未认清胆管病变的解剖结构和类型的情况下，经T管修复了损伤，导致了异常的胆管修复不当。术后即刻，腹腔引流引出大量胆汁。进行了T管胆管造影。尽管造影剂通过腹腔引流管渗漏，但修复不当未被发现。该患者因胆漏转诊至我院。重复进行超声和胆管造影检查，结果显示修复解剖结构异常（经T管行右肝管至左肝管吻合），有造影剂经腹腔引流管引出的证据。最终，患者接受了确定性手术治疗。通过Roux-en-Y肝空肠吻合术并置入经吻合口的外胆管支架，重建了胆管连续性。第二次手术后4年，患者目前情况良好。在回顾文献时我们发现了类似类型的损伤，但未找到类似的手术修复不当情况。我们提出了一种早期和晚期胆管损伤的治疗方案。
