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病例报告:腹腔镜胆囊切除术中发现异位肝(迷芽瘤)。

Case Report: Ectopic Liver (Choristoma) Discovered During Laparoscopic Cholecystectomy.

机构信息

Department of Surgery, Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia.

Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia.

出版信息

Am J Case Rep. 2021 Aug 23;22:e932784. doi: 10.12659/AJCR.932784.

Abstract

BACKGROUND Ectopic liver (EL) is liver tissue that is not attached to the mother liver, and is also known as choristoma and hepar succenturiatum. According to Watanabe's 1060-patient series, it has an incidence rate of less than 1% (0.47%). The absence of an anatomical attachment to the hepatic proper is a rare congenital departure from the norm, known as EL. EL is thought to be caused by abnormal hepatic tissue growth from the foregut diverticulum, particularly at cystic structures. CASE REPORT We report the successful management of a 47-year-old male patient, not known to have any medical illness, who was referred to the surgical team with a clinical picture of biliary colic. An ultrasound (US) abdomen was performed, and cholecystitis was confirmed. During a laparoscopic cholecystectomy, ET was identified by chance. He tolerated the operation well. Gallbladder histological examination revealed significant mucosal and wall ulcers, chronic inflammation, many black stones, no dysplasia or malignancy, and connected liver tissue measuring 12×5 mm. As a result, chronic calcular cholecystitis was confirmed, as was normal EL architecture and no evidence of malignancy. CONCLUSIONS We conclude that EL is a rare condition, but there have been cases reported in the literature. Imaging modalities such as US and computed tomography scans are recommended to rule out other underlying diagnoses and should be tailored to each individual when necessary. Because the presence of EL attached to the vesicle is a rare occurrence in the literature, a histological examination is required due to the elevated risk of hepatocellular carcinoma. Keeping such an abnormality in mind can help surgeons demarcate the embryological plane of dissection during cholecystitis to avoid tumor cell spillages if present.

摘要

背景 异位肝(EL)是指未附着于母体肝脏的肝组织,也称为迷芽瘤和肝副叶。根据 Watanabe 的 1060 例患者系列研究,其发病率低于 1%(0.47%)。缺乏与肝脏的解剖附着是一种罕见的先天性异常,称为 EL。EL 被认为是由前肠憩室的异常肝组织生长引起的,特别是在囊性结构中。

病例报告 我们报告了一例成功治疗的 47 岁男性患者,他没有已知的任何疾病,因胆绞痛被转介到外科团队。进行了腹部超声检查,确诊为胆囊炎。在腹腔镜胆囊切除术中,偶然发现 ET。他耐受手术良好。胆囊组织学检查显示明显的黏膜和壁溃疡、慢性炎症、许多黑结石、无发育不良或恶性肿瘤,以及连接肝脏组织大小为 12×5mm。因此,确诊为慢性结石性胆囊炎,EL 结构正常,无恶性肿瘤证据。

结论 EL 是一种罕见的疾病,但文献中有报道。推荐使用超声和计算机断层扫描等影像学手段排除其他潜在诊断,并在必要时针对每个个体进行个体化调整。由于文献中报道了附着在胆囊上的 EL 是罕见的,因此需要进行组织学检查,因为存在肝细胞癌的风险较高。如果存在这种异常,外科医生可以牢记这一点,以便在胆囊炎期间划定胚胎发育的解剖平面,避免肿瘤细胞溢出。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1f68/8404163/e32a9357a3c9/amjcaserep-22-e932784-g001.jpg

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