Hamilton C, Carmichael Sp, Bernard Ac
University of Kentucky, Lexington, USA.
J Surg Case Rep. 2012 Jun 1;2012(6):13. doi: 10.1093/jscr/2012.6.13.
In trauma, laparoscopic surgery is commonly utilized as a diagnostic rather than therapeutic measure (1). Its use is often negated because of exigency or limitations in visibility due to haemorrhage. In the present case, a 35-year-old male was involved in a motor vehicle collision and arrived haemodynamically stable with abdominal pain. Abdominal CT revealed liver laceration and active contrast extravasation near the gallbladder fossa. Although angiography with embolization would normally be used, exploratory laparoscopy was performed because of concern for gallbladder injury. The gallbladder was found to be perforated and nearly completely avulsed from the fossa. Laparoscopic cholecystectomy was performed and the patient recovered uneventfully. Gallbladder perforation after trauma is typically an incidental finding during operation for haemorrhagic shock or other indication. Early diagnosis and swift surgical intervention are required, usually via laparotomy. However, when diagnosed preoperatively in the stable trauma victim, gallbladder perforation can be treated successfully with laparoscopy.
在创伤情况下,腹腔镜手术通常用作诊断手段而非治疗措施(1)。由于紧急情况或出血导致视野受限,其应用常被否定。在本病例中,一名35岁男性遭遇机动车碰撞,入院时血流动力学稳定,但伴有腹痛。腹部CT显示肝脏裂伤以及胆囊窝附近有造影剂外渗。尽管通常会采用血管造影栓塞术,但由于担心胆囊损伤,还是进行了探查性腹腔镜检查。结果发现胆囊穿孔,且几乎完全从胆囊窝撕脱。遂行腹腔镜胆囊切除术,患者术后恢复顺利。创伤后胆囊穿孔通常是在因失血性休克或其他指征进行手术时偶然发现的。通常需要早期诊断并迅速进行手术干预,一般通过剖腹手术。然而,对于血流动力学稳定的创伤患者,如果术前诊断出胆囊穿孔,可通过腹腔镜手术成功治疗。