背景:腹腔镜胆囊切除术是胆结石疾病的常见手术选择,创伤小,恢复快。腹水是腹腔镜胆囊切除术后相对罕见的并发症,在术前肝功能异常的患者中更常见。然而,无基础肝病的患者在腹腔镜胆囊切除术后出现顽固性腹水的情况很少见.我们报告了一例腹腔镜胆囊切除术后由淋巴损伤引起的大量腹水。
方法:一名63岁女性因胆囊结石行腹腔镜胆囊切除术后第12天主诉腹部不适和腹胀。随后,患者出现自发性细菌性腹膜炎和尿量减少。腹部计算机断层扫描(CT)发现腹部积液。患者接受腹腔穿刺术,微浑浊的黄色腹水平均每天1500-2000毫升。腹水的实验室分析结果显示:血清-腹水白蛋白梯度(SAAG),11-12g/L;白蛋白,11-14g/L;甘油三酯,0.91mmol/L利尿剂治疗后,重复大量穿刺补充白蛋白,使用抗生素和肾血管舒张药物,病人的症状没有缓解。淋巴闪烁显像在腹腔中发现了少量放射性填充物。患者最终接受了手术,并检测并结扎了淋巴漏。腹水消失,患者恢复良好。
结论:对于乳糜性腹水的非典型特征患者,淋巴扫描可以帮助定位和定性诊断。保守治疗失败时可考虑手术治疗。
BACKGROUND: Laparoscopic cholecystectomy is a common surgical option for gallstone disease with minimal trauma and rapid recovery. Ascites is a relatively uncommon complication after laparoscopic cholecystectomy and is more frequently observed in patients with preoperative abnormal liver function. However, patients without underlying liver disease develop refractory ascites after laparoscopic cholecystectomy are rare. We report a
case of massive ascites caused by lymphatic injury after laparoscopic cholecystectomy.
METHODS: A 63-year-old woman complained of abdominal discomfort and distension at the twelfth day after a laparoscopic cholecystectomy for gallbladder stones. Subsequently, the patient developed spontaneous bacterial peritonitis and a decreased output of urine. Abdominal computed tomography (CT) identified abdominal effusion. The patient received abdominocentesis and the volume of slightly turbid yellow ascites averaged 1500-2000 ml per day. The results of laboratory analysis of ascitic fluid showed the following: serum-ascites albumin-gradient (SAAG), 11-12 g/L; albumin, 11-14 g/L; triglycerides, 0.91 mmol/L. After the diuretic therapy, repeated large-volume paracentesis with albumin supplementation, administration of antibiotics and renal vasodilating medications, the patient\'s symptoms did not relieve. Lymphoscintigraphy found a small amount of radioactive filling in the abdominal cavity. The patient finally received surgery with detection and ligation of the lymphatic leak. The ascites disappeared and the patient recovered well.
CONCLUSIONS: For patients with atypical characteristics of chylous ascites, lymphoscintigraphy could help to localize and qualify the diagnosis. Surgical treatment could be considered when conservative treatment fails.