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[腹腔镜胆囊切除术后医源性胆囊致右肝动脉延迟出血,因急性肝衰竭需进行肝移植:临床病例及文献复习]

[Delayed right hepatic artery haemorrhage after iatrogenic gallbladder by laparoscopic cholecystectomy that required a liver transplant due to acute liver failure: clinical case and review of the literature].

作者信息

Robles Campos Ricardo, Marín Hernández Caridad, Fernández Hernández Juan Angel, Sanchez Bueno Francisco, Ramirez Romero Pablo, Pastor Perez Patricia, Parrilla Paricio Pascual

机构信息

Unidad de Cirugía Hepática y Transplante Hepático, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.

出版信息

Cir Esp. 2011 Dec;89(10):670-6. doi: 10.1016/j.ciresp.2011.07.002. Epub 2011 Aug 30.

Abstract

INTRODUCTION

Right hepatic artery (RHA) injury after laparoscopic cholecystectomy (LC) may go unnoticed clinically, but can sometimes cause necrosis of the right lobe. Exceptionally, when the necrosis spreads to segment IV, fulminant liver failure (FLF) may occur, and an urgent liver transplantation (LT) may be required.

PATIENTS AND METHOD

We provide a review of the literature on patients with indication for an LT due to vascular damage caused by bile duct injury following LC. The case reported herein is the fourth described in the specialized literature of LT due to RHA injury after LC and the second of FLF after RHA injury.

RESULTS

LT due to RHA injury was performed in 3 of 13 patients reported in the literature: one LT was performed at 3 months due to FLF, after an extended right hepatectomy was performed, and the remaining two were performed due to secondary biliary cirrhosis. Our patient was transplanted due to FLF 15 days after the injury.

CONCLUSIONS

RHA injury after LC may require LT due to FLF. Although exceptional, this possibility should be considered when there are RHA complications that may require occlusion.

摘要

引言

腹腔镜胆囊切除术(LC)后右肝动脉(RHA)损伤在临床上可能未被察觉,但有时会导致右叶坏死。极个别情况下,当坏死蔓延至IV段时,可能会发生暴发性肝衰竭(FLF),可能需要紧急肝移植(LT)。

患者与方法

我们回顾了因LC后胆管损伤导致血管损伤而有LT指征患者的文献。本文报道的病例是专业文献中第四例因LC后RHA损伤而行LT的病例,也是第二例RHA损伤后发生FLF的病例。

结果

文献报道的13例患者中有3例行因RHA损伤的LT:1例在扩大右肝切除术后3个月因FLF行LT,其余2例因继发性胆汁性肝硬化行LT。我们的患者在损伤后15天因FLF接受移植。

结论

LC后RHA损伤可能因FLF而需要LT。虽然这种情况罕见,但当存在可能需要闭塞的RHA并发症时,应考虑这种可能性。

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