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胆囊结石病腹腔镜胆囊切除术后难治性乳糜漏:一例报告及文献复习

Refractory chyle leakage after laparoscopic cholecystectomy for gallstone disease: A case report and literature review.

作者信息

Yao Bao Z, Li Liang, Jiang Ming, Wang Jie, Zhang Jun

机构信息

Department of General Surgery, the Second People's Hospital of HeFei, Anhui Medical University Affiliated HeFei Hospital, HeFei, AnHui Province, China.

出版信息

Medicine (Baltimore). 2018 Jan;97(2):e9604. doi: 10.1097/MD.0000000000009604.

Abstract

RATIONALE

Gallstone disease is commonly worldwide and safely treated by laparoscopic cholecystectomy. Chylous ascites is a rare but serious complication of many abdominal operations.

PATIENT CONCERNS

We present a rare case of refractory chyle leakage post-LC for acute cholecystitis that is successfully treated in a 40-year-old man, and review current literature on the prevalence, diagnosis, and management of this complication.

DIAGNOSES

Refractory chyle leakage post-LC, a rare but serious complication after laparoscopic cholecystectomy.

INTERVENTIONS

Conservative treatment was given initially; however, the outcome was frustrating. Surgical intervention was given without further delay.

OUTCOMES

After the reoperation, conservative treatment was still maintained. After nearly 8 months of treatment, the patient recovered and then was discharged.

LESSONS

This case represents a previously unreported complication of refractory and high flow chyle leakage after laparoscopic cholecystectomy, which did not improve alter conservative management with dietary changes and other measures. So we suggest that surgical intervention should be given for refractory cases without further delay. It can not only shorten the disease progression, but also alleviate the sufferings of the patient.

摘要

理论依据

胆结石疾病在全球范围内普遍存在,通常可通过腹腔镜胆囊切除术安全治疗。乳糜性腹水是许多腹部手术罕见但严重的并发症。

患者情况

我们报告一例40岁男性急性胆囊炎行腹腔镜胆囊切除术后发生难治性乳糜漏的罕见病例,并回顾当前关于该并发症的患病率、诊断和管理的文献。

诊断

腹腔镜胆囊切除术后难治性乳糜漏,这是腹腔镜胆囊切除术后一种罕见但严重的并发症。

干预措施

最初给予保守治疗;然而,结果令人沮丧。未再延迟,立即进行了手术干预。

结果

再次手术后,仍维持保守治疗。经过近8个月的治疗,患者康复并出院。

经验教训

该病例代表了腹腔镜胆囊切除术后一种先前未报道的难治性高流量乳糜漏并发症,经饮食改变和其他措施的保守治疗后并未改善。因此,我们建议对于难治性病例应立即进行手术干预。这不仅可以缩短病程,还能减轻患者的痛苦。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e045/5943860/9c5a09665236/medi-97-e9604-g001.jpg

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