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腹腔镜胆囊切除术中发现的膀胱下迷走胆管:一例罕见病例报告及文献复习

Aberrant subvesical bile ducts identified during laparoscopic cholecystectomy: A rare case report and review of the literature.

作者信息

Mariolis-Sapsakos Theodoros, Zarokosta Maria, Zoulamoglou Menelaos, Piperos Theodoros, Papapanagiotou Ioannis, Sgantzos Markos, Birbas Konstantinos, Kaklamanos Ioannis

机构信息

University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece; Anatomy and Histology Laboratory, Nursing School, University of Athens, Greece.

University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece; Anatomy and Histology Laboratory, Nursing School, University of Athens, Greece.

出版信息

Int J Surg Case Rep. 2017;31:99-102. doi: 10.1016/j.ijscr.2017.01.022. Epub 2017 Jan 16.

Abstract

INTRODUCTION

Aberrant subvesical bile ducts are a scarce anatomical variation, consisted by a network of bile ducts located in the peri-hepatic capsule of the gallbladder fossa. These rare ducts are usually discovered intraoperatively and their presence poses the risk of bile injury and clinically significant bile leak.

PRESENTATION OF CASE

Aberrant subvesical bile ducts were unexpectedly identified in a young woman during laparoscopic cholecystectomy. These three ducts were clipped carefully for avoidance of bile duct injury and subsequent bile leak. The operation was uneventful. A meticulous review of the recent literature was conducted as well.

DISCUSSION

This unusual anatomical variation of the biliary tract is mainly discovered during the operation. Thus, surgical injury of these ducts is nearly inevitable and it provokes the severe complication of bile leak. Bile injury represents the most crucial and life-threatening postoperative complication of cholecystectomies. Surgeons in the right upper quadrant of the abdomen should be constantly aware of this rare anatomical variation.

CONCLUSION

Aberrant subvesical bile ducts are associated with a high risk of surgical bile duct injury. Nevertheless, meticulous operative technique combined with surgeons' perpetual awareness concerning this peculiar anatomical aberration leads to a safe laparoscopic cholecystectomy.

摘要

引言

膀胱下异常胆管是一种罕见的解剖变异,由位于胆囊窝肝周包膜内的胆管网络组成。这些罕见的胆管通常在手术中被发现,它们的存在会带来胆管损伤和具有临床意义的胆漏风险。

病例介绍

一名年轻女性在腹腔镜胆囊切除术中意外发现了膀胱下异常胆管。这三条胆管被小心夹闭以避免胆管损伤和随后的胆漏。手术过程顺利。同时对近期文献进行了细致回顾。

讨论

这种胆道的异常解剖变异主要在手术中被发现。因此,这些胆管的手术损伤几乎不可避免,并且会引发胆漏这一严重并发症。胆管损伤是胆囊切除术最关键且危及生命的术后并发症。腹部右上象限的外科医生应始终意识到这种罕见的解剖变异。

结论

膀胱下异常胆管与手术胆管损伤的高风险相关。然而,细致的手术技巧加上外科医生对这种特殊解剖变异的持续关注可实现安全的腹腔镜胆囊切除术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/da27/5266488/4a69ecf83456/gr1.jpg

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