腹腔镜胆囊切除术后支气管-胆管瘘

目的提高对腹腔镜胆囊切除术（LC）后支气管-胆管瘘的认识.方法对1例肝硬化伴支气管-胆管瘘患者的临床资料进行分析,并结合文献复习.结果LC可致胆囊破裂,胆汁、胆石漏入腹腔,引起腹腔感染、肝脓肿等,并可致膈肌穿孔、支气管-胆管瘘形成而持续由肺排出新鲜胆汁.结论支气管-胆管瘘实属罕见,痰液中含有高浓度胆红素为其主要临床表现.对LC术后腹腔内残留结石者应想尽一切办法取净结石.再次腹腔镜手术或开腹手术取出“丢失”于腹腔内的结石是治疗腹腔脓肿等并发症的有效方法.

Bronchus-biliary Fistula After Laparoscopic Cholecystectomy

Objective To highlight the characteristics of bronshus-biliary fistula after laparoscopic cholecystectomy(LC).Methods One patient with bronchus-biliary fistula was described and relevant literatures were reviewed.Results LC was associated with a significant risk of gallbladder perforations with bile and stone spillage.The retrieval of dropped stones was sometimes impossible, and intraperitoneally retained stones could be the source of serious complications,such as intraperitoneal infection,hepatic abscess,infection under diaphragm, diaphragm perforation and bronchus-biliary fistula. The latter caused fresh bile to be discharged from lung.Conclusion Bronchus-biliary fistula is a rare complication after LC.Its clinical character is high comcentration of bilirubin in sputum.It is very dangerous that gallstones are missed in the peritoneal cavity. Whenever gallstones are lost in the abdominal cavity,every effort should be made to find remove them to prevent late complications .Abdominal abscess treatment requires removal of missed stones by surgical incision or new laparoscopic procedure.