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腹腔镜胆囊切除术中同时发现并修复的两例膀胱下胆管损伤病例

Two Cases of Subvesical Bile Duct Injury Detected and Repaired Simultaneously during Laparoscopic Cholecystectomy.

作者信息

Kohga Atsushi, Suzuki Kenji, Okumura Takuya, Yajima Kiyoshige, Yamashita Kimihiro, Isogaki Jun, Kawabe Akihiro

机构信息

Division of Surgery, Fujinomiya City General Hospital, Fujinomiya, Japan.

出版信息

Case Rep Med. 2019 Mar 26;2019:3873876. doi: 10.1155/2019/3873876. eCollection 2019.

Abstract

INTRODUCTION

Subvesical bile duct (SVBD) injury is a secondary major cause of minor bile duct injury after laparoscopic cholecystectomy (LC). However, this injury is usually not recognized intraoperatively, but postoperatively.

CASE REPORT

Case 1: the patient was an 84-year-old female, preoperatively diagnosed with acute cholecystitis. During LC, a tiny hole in the gallbladder fossa from which bile juice oozing was confirmed. Suturing was performed laparoscopically. Case 2: the patient was an 81-year-old male, preoperatively diagnosed with cholelithiasis. Because of a previous history of gastrectomy, laparoscopic adhesiolysis around the gallbladder was performed. During dissection, a small amount of bile was oozing from the surface of the liver adjacent to the gallbladder fossa. Suturing was performed laparoscopically.

CONCLUSION

If a small amount of bile juice was detected, meticulous observation not only around the cystic duct stump but also the gallbladder fossa should be performed. Simultaneous laparoscopic suturing was feasible, and an ideal procedure against SVBD injury developed during LC.

摘要

引言

膀胱下胆管(SVBD)损伤是腹腔镜胆囊切除术(LC)后小胆管损伤的第二大主要原因。然而,这种损伤通常在术中未被识别,而是在术后才被发现。

病例报告

病例1:患者为一名84岁女性,术前诊断为急性胆囊炎。在LC手术过程中,确认胆囊窝有一个小孔,有胆汁渗出。进行了腹腔镜缝合。病例2:患者为一名81岁男性,术前诊断为胆结石。由于既往有胃切除术史,对胆囊周围进行了腹腔镜粘连松解术。在解剖过程中,胆囊窝附近的肝脏表面有少量胆汁渗出。进行了腹腔镜缝合。

结论

如果检测到少量胆汁,不仅应仔细观察胆囊管残端周围,还应观察胆囊窝。同时进行腹腔镜缝合是可行的,这是一种针对LC术中发生的SVBD损伤的理想手术方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/705b/6458879/21b74306bebf/CRIM2019-3873876.001.jpg

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