A Case Report of Hepatic Subcapsular Biloma and Literatures Review_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 張志超 ^1,2 , 胡文秀 ¹ ,  趙海平 ¹

1. ;
2. ;

Corresponding?author：

趙海平, Email: zhaohaiping007@aliyun.com

Keywords：

肝包膜下膽汁瘤; 膽囊切除術; 并發癥

DOI：

10.7507/1007-9424.20140181

Video：

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目的總結肝包膜下膽汁瘤（HSB）的病因、臨床診斷及治療方法。方法回顧性分析筆者所在醫院收治的1例HSB患者的臨床資料，并進行文獻復習。結果 12例患者中，術前診斷為膽總管結石/膽囊結石慢性膽囊炎4例，膽總管結石1例，膽囊結石2例，急性化膿性膽囊炎2例，不詳3例；行腹腔鏡膽囊切除術（LC）7例，行內窺鏡逆行胰膽管造影1例，行LC+腹腔鏡膽管取石術1例，行開腹膽囊切除術3例；發病至手術時間7～40 d，平均14.3 d；右肝9例，膽囊窩及右肝前葉膈頂部、膽囊窩及右肝后葉和左肝各1例；11例單發，1例左肝多發；HSB直徑7.6～29.1 cm，平均15.7 cm；肝臟包膜下積液量800～3 000 mL，平均1 400 mL；液體吸收時間7～120 d，平均37 d。主要治療方案為置管引流7例（包括手術開腹置管外引流2例），B超引導下反復穿刺抽吸4例，1例不詳；2例反復穿刺引流效果較差，行手術治療。結論 HSB的發病原因目前尚無統一意見，診斷首選影像學檢查，治療以保守治療+B超引導下經皮反復穿刺抽吸為主。

Citation： 張志超, 胡文秀, 趙海平. A Case Report of Hepatic Subcapsular Biloma and Literatures Review. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(6): 761-763. doi: 10.7507/1007-9424.20140181 Copy

1.	?Cervantes J, Rojas GA, Ponte R.Intrahepatic subcapsular biloma.A rare complication of laparoscopic cholecystectomy[J].Surg Endosc, 1994, 8(3):208-210.
2.	Shamiyeh A, Wayand W.Laparoscopic cholecysteetomy:early and late complication and their treatment[J].Langenbecks Arch Surg, 2004, 389(3):164-171.
3.	Rácz I, Rejchrt S, Hassan M.Complications of ERCP:ethical obligations and legal consequences[J].Dig Dis, 2008, 26(1):49-55.
4.	Leppard WM, Chavin KD, McGillicuddy JW.A what? Subcapsular biloma after laparoscopic cholecystectomy[J].Am Surg, 2011, 77(7):E131-E132.
5.	胡志前,吳德敬,王毅,等.腹腔鏡膽囊切除術并發肝包膜下積液二例報告[J].普外臨床, 1995, 10(5):260.
6.	陳晚平,唐衛民,宋煒,等.腹腔鏡膽囊切除術后肝包膜下膽汁瘤1例報告暨文獻復習[J].消化外科, 2005, 4(3):166-168.
7.	Mocanu SN, Rodríguez Blanco M, Palmer Sancho J, et al.Hepatic subcapsular biloma secondary to laparoscopic cholecystectomy[J].Cir Esp, 2012, 90(10):e41.
8.	Ramachandran A, Gupta SM, Johns WD.Various presentations of postcholecystectomy bile leak diagnosed by scintigraphy[J].Clin Nucl Med, 2001, 26(6):495-498.
9.	Hassani KI, Benjelloun el B, Ousadden A, et al.A rare case of hepatic subcapsular biloma after open cholecystectomy:a case report[J].Cases J, 2009, 15(2):7836.
10.	Dupas JL, Mancheron H, Sevenet F, et al.Hepatic subcapsular biloma.An unusual complication of endoscopic retrograde cholangiopancreatography[J].Gastroenterology, 1988, 94(5 Pt 1):1225-1227.
11.	Braithwaite BM, Cabanilla LT, Lilly M.Hepatic subcapsular biloma:a rare complication of laparoscopic cholecystectomy and common bile duct exploration[J].Curr Surg, 2003, 60(2):196-198.
12.	丁雪梅,陳紅,張駿,等.膽道術后并發癥肝包膜下膽汁瘤一例并文獻分析[J].中華肝膽外科雜志, 2013, 19(3):161-164.
13.	沈偉敏,陸貝,封光華.膽囊切除致醫源性肝外膽道損傷的外科診治[J].醫學研究雜志, 2012, 41(1):128-130.
14.	劉允怡,賴俊雄.對《膽管損傷的預防與治療指南(2008版)》的建議[J].中華消化外科雜志, 2008, 7(4):267.
15.	王毅,胡志前,吳德敬,等.腹腔鏡膽囊切除術后的少見并發癥[J].第二軍醫大學學報, 2002, 23(6):692-693.
16.	劉永雄.精心保護膽道樹:醫源性膽管損傷腹部創傷的特殊類型[J].中華肝膽外科雜志, 2009, 15(2):81-83.
17.	Fan MM, Li F, Zhang XW.Changes of the sphincter of Oddi motility in dog after cholecystectomy[J].J Dig Dis, 2012, 13(1):40-46.
18.	Ahn YH, Kim TH, Yang BJ, et al.A case of spontaneous biloma complicated with choledocholithiasis and chronic cholecystitis[J].Korean J Gastroenterol, 2005, 46(2):133-136.
19.	劉永雄.認真研習膽道生物力學重視保護膽胰結構和功能[J].中華肝膽外科雜志, 2012, 18(1):1-4.

1. ?Cervantes J, Rojas GA, Ponte R.Intrahepatic subcapsular biloma.A rare complication of laparoscopic cholecystectomy[J].Surg Endosc, 1994, 8(3):208-210.
2. Shamiyeh A, Wayand W.Laparoscopic cholecysteetomy:early and late complication and their treatment[J].Langenbecks Arch Surg, 2004, 389(3):164-171.
3. Rácz I, Rejchrt S, Hassan M.Complications of ERCP:ethical obligations and legal consequences[J].Dig Dis, 2008, 26(1):49-55.
4. Leppard WM, Chavin KD, McGillicuddy JW.A what? Subcapsular biloma after laparoscopic cholecystectomy[J].Am Surg, 2011, 77(7):E131-E132.
5. 胡志前,吳德敬,王毅,等.腹腔鏡膽囊切除術并發肝包膜下積液二例報告[J].普外臨床, 1995, 10(5):260.
6. 陳晚平,唐衛民,宋煒,等.腹腔鏡膽囊切除術后肝包膜下膽汁瘤1例報告暨文獻復習[J].消化外科, 2005, 4(3):166-168.
7. Mocanu SN, Rodríguez Blanco M, Palmer Sancho J, et al.Hepatic subcapsular biloma secondary to laparoscopic cholecystectomy[J].Cir Esp, 2012, 90(10):e41.
8. Ramachandran A, Gupta SM, Johns WD.Various presentations of postcholecystectomy bile leak diagnosed by scintigraphy[J].Clin Nucl Med, 2001, 26(6):495-498.
9. Hassani KI, Benjelloun el B, Ousadden A, et al.A rare case of hepatic subcapsular biloma after open cholecystectomy:a case report[J].Cases J, 2009, 15(2):7836.
10. Dupas JL, Mancheron H, Sevenet F, et al.Hepatic subcapsular biloma.An unusual complication of endoscopic retrograde cholangiopancreatography[J].Gastroenterology, 1988, 94(5 Pt 1):1225-1227.
11. Braithwaite BM, Cabanilla LT, Lilly M.Hepatic subcapsular biloma:a rare complication of laparoscopic cholecystectomy and common bile duct exploration[J].Curr Surg, 2003, 60(2):196-198.
12. 丁雪梅,陳紅,張駿,等.膽道術后并發癥肝包膜下膽汁瘤一例并文獻分析[J].中華肝膽外科雜志, 2013, 19(3):161-164.
13. 沈偉敏,陸貝,封光華.膽囊切除致醫源性肝外膽道損傷的外科診治[J].醫學研究雜志, 2012, 41(1):128-130.
14. 劉允怡,賴俊雄.對《膽管損傷的預防與治療指南(2008版)》的建議[J].中華消化外科雜志, 2008, 7(4):267.
15. 王毅,胡志前,吳德敬,等.腹腔鏡膽囊切除術后的少見并發癥[J].第二軍醫大學學報, 2002, 23(6):692-693.
16. 劉永雄.精心保護膽道樹:醫源性膽管損傷腹部創傷的特殊類型[J].中華肝膽外科雜志, 2009, 15(2):81-83.
17. Fan MM, Li F, Zhang XW.Changes of the sphincter of Oddi motility in dog after cholecystectomy[J].J Dig Dis, 2012, 13(1):40-46.
18. Ahn YH, Kim TH, Yang BJ, et al.A case of spontaneous biloma complicated with choledocholithiasis and chronic cholecystitis[J].Korean J Gastroenterol, 2005, 46(2):133-136.
19. 劉永雄.認真研習膽道生物力學重視保護膽胰結構和功能[J].中華肝膽外科雜志, 2012, 18(1):1-4.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A Case Report of Hepatic Subcapsular Biloma and Literatures Review

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