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1例由T管隐匿移位引起的罕见梗阻性黄疸病例。

A case of rare obstructive jaundice induced by concealed displacement of T-tube.

作者信息

Yangjun Gu, Qingqing Fang, Zhitao Chen, Qiyong Li

机构信息

Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, #848 Dongxin Road, Hangzhou 310000, P. R. China.

Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, #3 Qingchun Road, Hangzhou, 310016, P. R. China.

出版信息

J Surg Case Rep. 2024 Sep 18;2024(9):rjae587. doi: 10.1093/jscr/rjae587. eCollection 2024 Sep.

DOI:10.1093/jscr/rjae587
PMID:39296423
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11410385/
Abstract

We present the case of a 32-year-old woman who was ultimately diagnosed with obstructive jaundice. She exhibited persist jaundice, liver dysfunction with normal drainage of T-tube (400-500 ml per day), and normal stools. Prior to her admission to our department, she had undergone a cholecystectomy and T-tube placement following common bile duct exploration for cholelithiasis. Although her serum bilirubin levels initially decreased post-surgery, it rose sharply after T-tube cholangiography. The diagnosis remained unclear until we performed endoscopic retrograde cholangiopancreatography (ERCP), which revealed that the obstructive jaundice was induced by improper T-tube placement. There were few such presentations reported before, and it's particularly unusual to encounter jaundice following T-tube placement. Moreover, diagnosing and treating this condition can be challenging when T-tube drainage appears normal. Thus, our case report provides a unique contribution to the literature on obstructive jaundice.

摘要

我们报告一例最终被诊断为梗阻性黄疸的32岁女性病例。她表现为持续性黄疸、肝功能障碍,T管引流正常(每天400 - 500毫升),且大便正常。在她入住我们科室之前,因胆结石行胆总管探查术后接受了胆囊切除术和T管置入术。尽管术后她的血清胆红素水平最初有所下降,但在T管胆管造影术后急剧上升。在我们进行内镜逆行胰胆管造影(ERCP)之前,诊断一直不明确,ERCP显示梗阻性黄疸是由T管放置不当所致。此前鲜有此类病例报道,尤其罕见的是T管置入术后出现黄疸。此外,当T管引流看似正常时,诊断和治疗这种情况可能具有挑战性。因此,我们的病例报告为梗阻性黄疸的文献提供了独特的贡献。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3748/11410385/d1aebe6cb628/rjae587f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3748/11410385/b84cbc154be9/rjae587f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3748/11410385/d1aebe6cb628/rjae587f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3748/11410385/b84cbc154be9/rjae587f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3748/11410385/d1aebe6cb628/rjae587f2.jpg

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本文引用的文献

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Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy for patients with gallbladder and common bile duct stones a meta-analysis of randomized controlled trials.腹腔镜胆总管探查术与内镜逆行胰胆管造影术联合腹腔镜胆囊切除术治疗胆囊胆总管结石的比较:一项随机对照试验的荟萃分析。
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World J Gastrointest Surg. 2023 Feb 27;15(2):169-176. doi: 10.4240/wjgs.v15.i2.169.
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Jaundice as a Diagnostic and Therapeutic Problem: A General Practitioner's Approach.黄疸的诊断和治疗问题:全科医生的方法。
Dig Dis. 2022;40(3):362-369. doi: 10.1159/000517301. Epub 2021 May 20.
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J Minim Access Surg. 2020 Jul-Sep;16(3):206-214. doi: 10.4103/jmas.JMAS_146_18.
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Clinical Approach to Patients With Obstructive Jaundice.阻塞性黄疸患者的临床诊疗方法
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Cochrane Database Syst Rev. 2013 Sep 3(9):CD003327. doi: 10.1002/14651858.CD003327.pub3.
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