【作者】 王军；

【导师】 沈世强；

【作者基本信息】 武汉大学 ， 外科学， 2005， 硕士

【摘要】 患者祈某,男性,70岁,离休干部,住院号:571607。因腹腔镜胆囊切除术(laparoscopie cholecystectomy,LC)后黄疸并逐渐加重4天转入我院。既往有慢性结石性胆囊炎、胃溃疡病史。病人于5天前在外地医院全麻下行LC,术后第2天出现皮肤、巩膜黄染,伴右上腹隐痛,余无其他不适。该患者术前肝功能大致正常,术后第2天和第4天肝功能检查示ALT、ALP、γ-GT、T-BIL及D-BIL呈进行性上升,上腹部MRI+MRCP示肝门部胆管中断、肝内胆管轻度扩张及管壁增厚,B超示肝门部异常回声,约2.0cm×1.5cm大小。术后患者精神较差,大便未解,小便色黄,遂转入我院,收治入我院普通外科。病人入院体格检查示生命体征正常,巩膜、全身皮肤明显黄染,剑突下部、脐部及右锁骨中线肋缘下部可见三处长约0.5～1.2cm手术伤口,愈合良好,心肺及腹部检查无明显异常。本院B超示左、右肝内胆管轻度扩张,胆囊窝处见3.8cm×1.8cm液性暗区,肝功能检查(LC术后第6天)示上述诸指标较LC术后第4天显著上升,尿常规示胆红素(2+)。患者入院后第3天行剖腹探查证实为肝总管横断伤、慢性胆管炎,行左右肝管空肠Roux-en-Y吻合术,术后第11天治愈出院。术后随访至今无异常。更多还原

【Abstract】 A 70-year-old man was referred to our hospital for gradual aggravating jaundice with hidden pain after laparoscopic cholecystectomy for 4 days. Significant past history included chronic cholecystolithiasis and gastric ulcer. The patient had ever been treated with laparoscopic cholecystectomy in other hospital 5 days ago, but the postoperative patient appeared jaundice of skin and sclera, and the status of energy of patient was poor, the color of urine was shading yellow. The preoperative liver function of the patient was rough normal, however the volume of liver function include ALT, ALP, γ-GT, T-BIL and D-BIL gradually ascended. Moreover Intrahepatic bile ducts were found slight dilatation and the wall of bile duct was incrassated and the image of porta hepatic was broken with upper abdomen examination of MRI and MRCP, meanwhile about 2.0cmx 1.5cm size abnormal echo was found at porta hepatic by ultrasound, so the patient was delivered to the general surgery of our hospital. Physical examination found his vital sign is normal, skin and sclera stained yellow, about three long 0.5-1.2cm operative wound of laparoscopic cholecystectomy can be seen, which healed up. It was not found obviously abnormality in his heart、 lungs and abdomen with physical examination. Later days the patient was recheck by ultrasound in our hospital, the size of abnormal echo was to achieve 3.8cm× 1.8cm in fossa of gallbladder. The liver function after laparoscopic cholecystectomy 6 days markedly ascended compare to 2 days ago. Urine routine showed urobilin was (2+). So the patient was delivered to operation room with exploratory laparotomy after hospitalization 3 days and diagnosed common hepatic duct transection hurt and chronic cholangitis. Then Roux-en-Y hepaticojejunostomy was used successfully to repair transaction hurt. The patient was rehabilitation discharge after postoperative 11 days. The patient was normal by postoperation fellow-up.更多还原