腹腔鏡膽囊切除術後遺留膽結石併發症之病例報告文獻回顧

Complication of Spilled Gallstone after Laparoscopic Cholecystectomy: A Case Report and Literature Review

研究背景和目的：腹腔鏡膽囊切除手術是20年來公認針對症狀性膽道結石症的標準治療方法，常見的術中併發症為膽囊穿孔（破裂）以及結石溢漏。幾乎所有結石都會被清除以避免後續併發症。研究方法：本文描述一位75歲女性因右側腰部腫塊疼痛而就醫，此病人曾於20個月前接受腹腔鏡膽囊切除及總膽管探查手術。後續因泌尿系統結石引起腰痛，陸續接受腹腔電腦斷層檢查。追朔系列影像發現有高密度病灶由總膽管的位置漸漸移動到右後側腹壁。研究結果：病人接受腫塊切除手術治療，腫塊中發現兩個結石狀物體，結石分析為膽結石成分，因此診斷為膽結石肉芽腫。結論：結石滲漏可能會引起術後併發症，尤其是遺留結石數月或數年後的症狀會增加診斷的挑戰及治療的困難。因此術中謹慎處理膽囊及結石避免滲漏、詳細的病歷紀錄、和後續對於併發症的敏感度，是臨床醫師需要注意的課題。

 

In this article, we report the case of a 75-year-old female who was admitted to our hospital due to a painful mass over her right flank region. Twenty months prior to the admission, the patient had undergone laparoscopic cholecystectomy (LC). The computed tomography images revealed hyperdense lesions located at the common bile duct that had migrated to the abdominal wall. A surgical removal of two stones and pus content was performed. Based on the stone analysis and the surgical history, the patient was diagnosed with gallstone granuloma. After a short period of hospitalization, the patient was discharged with no complications. We believe that our report makes a significant contribution to the literature because reports of infectious complications due to unretrieved stones after LC are rare.