胆囊缺如——我们的经验及文献综述
Agenesis of gallbladder - our experience and a review of literature.
作者信息
Chowbey P K, Dey A, Khullar R, Sharma A, Soni V, Baijal M, Mittal T
机构信息
Minimal Access and Bariatric Surgery Centre, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110 060 India.
出版信息
Indian J Surg. 2009 Aug;71(4):188-92. doi: 10.1007/s12262-009-0066-8. Epub 2009 Sep 2.
BACKGROUND
Agenesis of gallbladder is a rare congenital anomaly. Variable diagnostic approaches, perioperative management strategies and postoperative follow up protocols provide a dilemma to its correct diagnosis and management.
METHODS
We hereby present five patients with agenesis of gallbladder encountered in our institution between 1992 to 2008. Four out of five patients had symptoms suggestive of gallstones including upper abdominal pain and acid dyspepsia, which were further substantiated by ultrasound reports showing shrunken contracted gallbladder with calculi.
RESULTS
On laparoscopy the gallbladder was absent in all five patients leading to conversion to laparotomy in the initial three patients. With increasing experience, the next two patients were diagnosed conclusively by laparoscopy to have agenesis of gallbladder, without the need for conversion which was further confirmed by post operative imaging studies.
CONCLUSION
Gallbladder agenesis is rarely encountered in clinical practice. With increased experience in laparoscopy, the condition no longer mandates conversion to laparotomy for confirmation of diagnosis. Symptomatic improvement occurs in all patients following surgical intervention.
背景
胆囊缺如是一种罕见的先天性异常。多样的诊断方法、围手术期管理策略及术后随访方案给其正确诊断和管理带来了难题。
方法
我们在此呈现1992年至2008年间在我院遇到的5例胆囊缺如患者。5例患者中有4例有提示胆结石的症状，包括上腹部疼痛和胃酸消化不良，超声报告显示胆囊萎缩并伴有结石，进一步证实了这些症状。
结果
在腹腔镜检查中，所有5例患者均未发现胆囊，最初3例患者因此转为开腹手术。随着经验的增加，后2例患者通过腹腔镜检查确诊为胆囊缺如，无需转为开腹手术，术后影像学检查进一步证实了这一诊断。
结论
胆囊缺如在临床实践中很少见。随着腹腔镜检查经验的增加，这种情况不再需要转为开腹手术来确诊。所有患者在手术干预后症状均有改善。
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