Fukuhisa Haruhi, Sakoda Masahiko, Hiwatashi Kiyokazu, Iino Satoshi, Minami Koji, Hashiguchi Motoyuki, Kawasaki Yota, Kurahara Hiroshi, Mataki Yuko, Maemura Kosei, Shinchi Hiroyuki, Ueno Shinichi, Natsugoe Shoji
Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
Int J Surg Case Rep. 2017;39:159-163. doi: 10.1016/j.ijscr.2017.08.018. Epub 2017 Aug 18.
The treatments of excluded bile duct leakage after hepatectomy are not easy and various strategies have been reported, such as surgery, ethanol or fibrin glue injection, and portal vein embolization.
A 72-year-old man with a surgical history of laparoscopic ileocecal resection for diverticular bleeding was diagnosed as having hepatocellular carcinoma. Right hemihepatectomy was performed, and computed tomography examination on postoperative day 9 showed abdominal fluid collection in the right subphrenic space. Percutaneous intra-abdominal fluid drainage was performed and it was diagnosed as bile leakage. After that it was diagnosed as excluded bile leakage from the Spiegel lobe by drip infusion cholangiographic-computed tomography and endoscopic retrograde cholangiography. To improve this clinical condition, we performed the Spiegel lobe excision on postoperative day 48. The postoperative course was uneventful and the patient was discharged.
According to the postoperative examination, it appeared that the bile duct from the Spiegel lobe joined to the right main bile duct or the bile duct of the right posterior section. This bile duct anomaly was not detected preoperatively on imaging examination. It is most likely that the bile duct from the Spiegel lobe was cut when the hepatoduodenal ligament in the hepatic hilum was peeled. To prevent excluded bile leakage, the hepatoduodenal ligament should be carefully peeled and ligated instead of using energy devices.
We consider that surgical treatment for postoperative excluded bile leakage is both a quick and reliable procedure in patients with acceptable liver function and anatomical subject.
肝切除术后非吻合口胆管漏的治疗并不容易，已有多种治疗策略被报道，如手术、乙醇或纤维蛋白胶注射以及门静脉栓塞。
一名72岁男性，有因憩室出血行腹腔镜回盲部切除术的手术史，被诊断为肝细胞癌。行右半肝切除术，术后第9天的计算机断层扫描检查显示右膈下间隙有腹腔积液。进行了经皮腹腔引流，诊断为胆漏。此后，通过滴注胆管造影计算机断层扫描和内镜逆行胆管造影诊断为来自斯皮格尔叶的非吻合口胆漏。为改善这种临床情况，我们在术后第48天行斯皮格尔叶切除术。术后病程顺利，患者出院。
根据术后检查，斯皮格尔叶的胆管似乎汇入右主胆管或右后段胆管。术前影像学检查未发现这种胆管异常。很可能在肝门处的肝十二指肠韧带剥离时切断了斯皮格尔叶的胆管。为防止非吻合口胆漏，应小心剥离和结扎肝十二指肠韧带，而不是使用能量器械。
我们认为，对于肝功能和解剖条件可接受的患者，手术治疗术后非吻合口胆漏是一种快速且可靠的方法。
