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胆囊相关的异位肝:腹腔镜胆囊切除术期间的罕见发现。

Gallbladder-associated ectopic liver: A rare finding during a laparoscopic cholecystectomy.

作者信息

Martinez Carlos Augusto Real, de Resende Hermínio Cabral, Rodrigues Murilo Rocha, Sato Daniela Tiemi, Brunialti Cyntia Viegas, Palma Rogério Tadeu

机构信息

Department of Surgery of São Francisco Medical University Hospital, Av. São Francisco de Assis, 218, CEP: 12916-900, Bragança Paulista, São Paulo, Brazil.

出版信息

Int J Surg Case Rep. 2013;4(3):312-5. doi: 10.1016/j.ijscr.2013.01.006. Epub 2013 Jan 19.

Abstract

INTRODUCTION

Ectopic hepatic tissue is due to an uncommon failure of embryological liver development that is rarely described in the world medical literature. The incidence of ectopic liver (EL) has been reported to be anywhere from 0.24% to 0.47% as diagnosed at laparotomy or laparoscopy. We describe a case of EL adherent to the gallbladder, removed at laparoscopic cholecystectomy.

PRESENTATION OF CASE

A 37-year-old female was admitted for elective cholecystectomy having had an episode of acute cholecystitis provoked by gallstones. During the procedure, a 30mm×10mm×5mm section of EL tissue attached to the anterior wall of the gallbladder was identified and removed by en-bloc excision during laparoscopic cholecystectomy. Histological examination confirmed the absence of malignant degeneration of the hepatic tissue. The patient recovered well postoperatively and was discharged the day after the operation. She was well when seen six months later.

DISCUSSION

EL has been reported in several sites, such as the gallbladder, gastrohepatic ligament, adrenal glands, esophagus, and thoracic cavity. EL is often clinically silent and discovered incidentally during abdominal surgical procedures or autopsies. Because patients with ectopic liver may suffer complications such as torsion, peritoneal bleeding, fatty change, and evolution to cirrhosis or malignant degeneration to hepatocellular carcinoma, any ectopic liver tissue needs to be correctly identified and removed.

CONCLUSION

Despite the rare occurrence of EL, it should be recognized and removed by the surgeon to prevent a higher risk of complications and malignant transformation.

摘要

引言

异位肝组织是胚胎期肝脏发育异常罕见的结果,在世界医学文献中鲜有描述。据报道,经剖腹手术或腹腔镜检查诊断的异位肝(EL)发生率为0.24%至0.47%。我们描述了一例附着于胆囊的异位肝病例,该病例在腹腔镜胆囊切除术时被切除。

病例介绍

一名37岁女性因胆结石引发急性胆囊炎发作而入院接受择期胆囊切除术。在手术过程中,在腹腔镜胆囊切除术时发现并通过整块切除移除了附着于胆囊前壁的一块30mm×10mm×5mm的异位肝组织。组织学检查证实肝组织无恶性变。患者术后恢复良好,术后第二天出院。六个月后复诊时情况良好。

讨论

异位肝已在多个部位被报道,如胆囊、肝胃韧带、肾上腺腺、食管和胸腔。异位肝通常在临床上无明显症状,在腹部外科手术或尸检时偶然发现。由于异位肝患者可能会出现诸如扭转、腹腔内出血、脂肪变性以及发展为肝硬化或恶性变为肝细胞癌等并发症,任何异位肝组织都需要被正确识别并切除。

结论

尽管异位肝罕见,但外科医生应认识到并将其切除,以防止出现更高的并发症风险和恶性转化。

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