Palermo Mariano, Trelles Nelson, Gagner Michel
Mount Sinai Medical Center, Miami Beach, FL, USA.
Surg Innov. 2011 Mar;18(1):105-9. doi: 10.1177/1553350610395033. Epub 2011 Jan 19.
Incidence of bile duct injury has been reported more frequently following laparoscopic cholecystectomy.
A 43-year-old female with a past medical history of laparoscopic cholecystectomy that was converted to open because of a common bile duct injury now presents with a stenosis at the hepaticojejunostomy that is causing recurrent cholangitis episodes. After the lysis of adhesions and dissection of the anastomotic area, a stricture was identified. The authors exposed and redid the hepaticojejunostomy with 4-0 Monocryl sutures without tension. The follow-up period was unremarkable. No leaks were documented, and the patient was discharged home on postoperative day 3.
After percutaneous or endoscopic procedure failure for the treatment of hepaticojejunostomy strictures, the laparoscopic redo anastomosis is safe and feasible when performed by surgeons who are strongly trained in advanced laparoscopic surgery.
据报道,腹腔镜胆囊切除术后胆管损伤的发生率更为频繁。
一名43岁女性,既往有腹腔镜胆囊切除术病史,因胆总管损伤转为开腹手术,现因肝空肠吻合口狭窄导致复发性胆管炎发作。在粘连松解和吻合口区域解剖后,发现一处狭窄。作者用4-0单丝可吸收缝线无张力地暴露并重新进行了肝空肠吻合术。随访期间无异常。未记录到渗漏情况,患者术后第3天出院回家。
在经皮或内镜治疗肝空肠吻合口狭窄失败后,由接受过高级腹腔镜手术强化培训的外科医生进行腹腔镜再次吻合术是安全可行的。