胆道术后并发症肝包膜下胆汁瘤一例并文献分析  

Hepatic subcapsular biloma： a postoperative complication following biliary surgery

作　　者：丁雪梅[1] 陈红[2] 张骏[1] 孙文兵[1] 

机构地区：[1]首都医科大学附属北京朝阳医院肝胆外科西区,100043 [2]首都医科大学附属北京朝阳医院病理科,100043

出　　处：《中华肝胆外科杂志》2013年第3期161-164,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：北京市卫生系统高层次卫生技术人才培养项目（2009-3-11）

摘　　要：报道经治的1例腹腔镜胆囊切除术后HSB的临床资料，并结合文献已报道的9例HSB进行回顾性总结，探讨其发病机制。HSB多见于单纯性胆囊切除术后，胆囊切除术加胆管探查术、内窥镜逆行胰胆管造影术后也可发生。主要症状为术后早期上腹部阵发性绞痛，饮食后加重。影像学表现为肝脏包膜下大量积液。经皮穿刺治疗有效。HSB罕有报道，其发病机制可能与胆道术后十二指肠乳头括约肌功能失调及其导致的胆道压力持续升高有关。应进一步加强对胆道术后十二指肠乳头括约肌功能失调及其相关并发症（如胆绞痛、HSB等）的研究。A rarely reported postoperative complication following biliary surgery, and to dis- cuss its possible mechanism. This article summarizes 1 reported HSB case that developed after laparo- scopic cholecystectomy in our department and 9 other cases reported in literature. HSB occurred most frequently after simple cholecystectomy in addition to post operative bile duct exploration with chole- cystectomy or endoscopic retrograde cholangiopancreatography. The main clinical presentation of HSB was paroxysmal colic in the upper abdomen early in the postoperative period, which could be induced after a meal. Imaging revealed subcapsular hepatic fluid collection, and successful treatment involved placement of a percutaneous drain in the biloma. The mechanism of HSB still needs to he clarified even though it is a rarely reported postoperative complication following biliary surgery. We hypothesize, af- ter analyzing these 10 cases, that sphincter of Oddi dysfunction after biliary surgery and the subse- quent persistence of high biliary system pressure may be the root cause of HSB formation. More awareness should be paid to the changes of the sphincter＇s motility after biliary surgery and its related complications （biliary colic, HSB etc. ）.

关 键 词：胆汁淤积 胆囊切除术 腹腔镜 手术后并发症 

分 类 号：R657.4[医药卫生—外科学]