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胆囊切除术后严重血管胆管损伤经右肝切除并跳跃式移植至剩余左肝叶成功治愈。

Severe case of post cholecystectomy vasculobiliary injury successfully treated by right hepatectomy with a jump graft to the remaining left hepatic lobe.

作者信息

Marino Carlo, Obaid Ignacio, Ochoa Gabriela, Jarufe Nicolás, Martínez Jorge A, Briceño Eduardo

机构信息

Department of Digestive Surgery, Pontificia Universidad Católica de Chile's Hospital, Santiago, Chile.

出版信息

J Surg Case Rep. 2020 Sep 24;2020(9):rjaa319. doi: 10.1093/jscr/rjaa319. eCollection 2020 Sep.

DOI:10.1093/jscr/rjaa319
PMID:33005319
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7515513/
Abstract

Vasculobiliary injuries (VBI) caused by cholecystectomies are infrequent but extremely serious. We report a case of a severe VBI successfully treated at our center. A 22-year-old woman underwent an open cholecystectomy as treatment for acute cholecystitis and bile duct stones. She was transferred to our center on postoperative Day 4 because of progressive jaundice and encephalopathy. After a proper investigation, we found an extreme VBI with infarction of the right hepatic lobe associated with complete interruption of the portal vein and proper hepatic artery flows and full section of the common hepatic duct. Right hepatectomy with portal-Rex shunt revascularization of the left hepatic lobe and Roux-en-Y hepaticojejunostomy to the left hepatic duct was done. The patient was discharged on the 60th postoperative day. Discussion: This case shows the successful surgical treatment of a severe cholecystectomy's VBI, avoiding an emergency liver transplant.

摘要

胆囊切除术引起的血管胆管损伤（VBI）虽不常见但极其严重。我们报告了一例在本中心成功治疗的严重VBI病例。一名22岁女性因急性胆囊炎和胆管结石接受了开腹胆囊切除术。术后第4天，由于进行性黄疸和脑病，她被转至我们中心。经过适当检查，我们发现了一种严重的VBI，伴有右肝叶梗死，同时门静脉和肝固有动脉血流完全中断，肝总管完全离断。实施了右肝切除术，同时对左肝叶进行门静脉-雷克斯分流血管重建，并对左肝管进行Roux-en-Y肝空肠吻合术。患者术后第60天出院。讨论：该病例展示了对严重胆囊切除术后VBI的成功手术治疗，避免了紧急肝移植。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e415/7515513/350c70639e63/rjaa319f9.jpg
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本文引用的文献

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Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era.胆管损伤（BDI）在腹腔镜胆囊切除术的先进时代。
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