Stephens Michael, Ruddle Angus, Young W Tudor
Department of Surgery, Princess of Wales Hospital, Bridgend, UK.
Surg Laparosc Endosc Percutan Tech. 2010 Jun;20(3):e103-4. doi: 10.1097/SLE.0b013e3181df9b56.
Dropped clips during laparoscopic cholecystectomy are not uncommon and although most surgeons would make attempts to retrieve them, this is not always straightforward and therefore such objects are on occasion left in the peritoneal cavity. Cystic duct clips or hemostatic clips migrating into the common bile duct after biliary surgery, although rare are well recognized and assumed to relate to improper clip application, bile leak (usually subclinical), inflammation, and subsequent necrosis, allowing the clips to erode directly into the common bile duct. We present a case of an open endoscopic clip, which was dropped at the time of an uncomplicated laparoscopic cholecystectomy, migrating into the common bile duct and causing partial biliary obstruction and its subsequently successful endoscopic removal.
腹腔镜胆囊切除术中夹子掉落并不罕见,尽管大多数外科医生会尝试取出,但这并非总是一帆风顺,因此这些物体有时会留在腹腔内。胆囊管夹子或止血夹在胆道手术后迁移至胆总管,虽然罕见但已得到充分认识,推测与夹子应用不当、胆漏(通常为亚临床)、炎症及随后的坏死有关,使得夹子直接侵蚀进入胆总管。我们报告一例在简单的腹腔镜胆囊切除术中掉落的开放型内镜夹子迁移至胆总管并导致部分胆道梗阻,随后成功通过内镜取出的病例。