Phẫu thuật nội soi điều trị bệnh lý ống mật chủ giãn thành nang do sỏi mật: Báo cáo ca lâm sàng và điểm lại y văn

Tóm tắt

Giãn đường mật là một hình thái tổn thương hay gặp trên lâm sàng, do nhiều bệnh lý khác nhau, hay gặp nhất là sỏi ống mật chủ (OMC), viêm tụy mạn và túi thừa Vater 1. Dấu hiệu phổ biến của sỏi mật là giãn đường mật trong và ngoài gan lan tỏa, tuy nhiên có trường hợp OMC giãn đơn thuần không kèm theo giãn đường mật trong gan. Tiên lượng của bệnh này là tốt, tuy nhiên cần loại trừ các nguyên nhân như nang OMC, viêm tụy bằng sinh thiết tức thì để có chẩn đoán và điều trị phù hợp nhất. Chúng tôi xin báo cáo một trường hợp người bệnh (NB) nữ, 19 tuổi mắc sỏi mật gây giãn OMC khu trú dạng nang được phẫu thuật nội soi thành công.

Từ khóa: Giãn đường mật khu trú, sỏi mật, nang ống mật chủ, phẫu thuật nội soi.

Tài liệu tham khảo

1. Smith I, Monkemuller K, Wilcox CM. Incidentally Identified Common Bile Duct Dilatation: A Systematic Review of Evaluation, Causes, and Outcome. Journal of clinical gastroenterology. 2015;49(10):810-815.
2. Malik S, Kaushik N, Khalid A, et al. EUS yield in evaluating biliary dilatation in patients with normal serum liver enzymes. Digestive diseases and sciences. 2007;52(2):508-512.
3. Oppong KW, Mitra V, Scott J, et al. Endoscopic ultrasound in patients with normal liver blood tests and unexplained dilatation of common bile duct and or pancreatic duct. Scandinavian journal of gastroenterology. 2014;49(4):473-480.
4. Songur Y, Temuçin G, Sahin B. Endoscopic ultrasonography in the evaluation of dilated common bile duct. Journal of clinical gastroenterology. 2001 ;33(4):302-305.
5. Di Serafino M, Gioioso M, Severino R, et al. Ultrasound findings in paediatric cholestasis: how to image the patient and what to look for. Journal of ultrasound. 2020;23(1):1-12.
6. Jeon J, Song SY, Lee KT, Lee KH, Bae MH, Lee JK. Clinical significance and long-term outcome of incidentally found bile duct dilatation. Digestive diseases and sciences. 2013;58(11):3293-3299.
7. Babbitt DP. [Congenital choledochal cysts: new etiological concept based on anomalous relationships of the common bile duct and pancreatic bulb]. Annales de radiologie. 1969;12(3):231-240.
8. Matsumoto Y, Uchida K, Nakase A, Honjo I. Clinicopathologic classification of congenital cystic dilatation of the common bile duct. American journal of surgery. 1977;134(5):569-574.
9. Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. The American Journal of Surgery. 1977;134(2):263-269.
10. Todani T, Watanabe Y, Toki A, Morotomi Y. Classification of congenital biliary cystic disease: special reference to type Ic and IVA cysts with primary ductal stricture. Journal of hepato-biliary-pancreatic surgery. 2003;10(5):340-344.
11. Arora A, Mukund A, Thapar S, Alam S. Anomalous Pancreaticobiliary Junction. Journal of Pediatric Gastroenterology and Nutrition. 2014;58(2).
12. Lee HC, Yeung CY, Fang SB, Jiang CB, Sheu JC, Wang NL. Biliary cysts in children–long-term follow-up in Taiwan. Journal of the Formosan Medical Association = Taiwan yi zhi. 2006;105(2):118-124.
13. Weng SC, Lee HC, Yeung CY, Chan WT, Liu HC, Jiang CB. Choledochal cyst as an important risk factor for pediatric gallstones in low-incidence populations: A single-center review. Pediatrics and neonatology. 2020;61(6):598-605.
14. Thơ TĐ. Nghiên cứu kết quả ứng dụng máy bơm nước điều khiển áp lực trong nội soi tán sỏi điện thủy lực điều trị sỏi trong gan tại bệnh viện Việt Đức. Y học Việt Nam. 2015;tháng 7(số 1):53-57.
15. Nam NH. Nghiên cứu kỹ thuật và kết quả nội soi tán và lấy sỏi đường mật qua đường hầm Kehr trong điều trị sỏi mật sót sau mổ, Trường Đại học Y Hà Nội 2006.
16. Ragot E, Mabrut JY, Ouaissi M, et al. Pancreaticobiliary Maljunctions in European Patients with Bile Duct Cysts: Results of the Multicenter Study of the French Surgical Association (AFC). World journal of surgery. 2017;41(2):538-545.
17. Soares KC, Arnaoutakis DJ, Kamel I, et al. Choledochal cysts: presentation, clinical differentiation, and management. J Am Coll Surg. 2014;219(6):1167-1180.

Laparoscopic surgery for lithiasis local choledochal dilatation diagnosed a cyst: Case report and literature reviews

Do Tuan Anh (1), Nguyen Thi Lan (1), Do Hai Dang (2), Luong Cong Dinh (2)

1. Viet Duc University Hospital
2. Hanoi Medical University

Received date: 08 Feb 2021

Accepted date:  24 May 2021

Published date: 21 June 2021

Abstract

Biliary dilation is common in clinical practice and originates from many pathologies; among them, choledocholithiasis, chronic pancreatitis and periampullary diverticula (PAD) are the most common. Popular signs of cholelithiasis is diffuse dilatation of the intra- and extrahepatic bile duct, however, in some cases, it might be local dilatation of the common bile duct without intrahepatic bile duct dilatation. The long-term outcome is favorable, however, it is necessary to rule out other causes such as choledochal cyst, pancreatitis by frozen section in order to have a proper diagnosis and treatment. We describe a 19-year-old female patient with local dilation of the common bile duct due to choledocholithiasis that was operated laparoscopically with success.

Key word: Local common bile duct dilation, gallstones, choledochal cyst, laparoscopy.

Reference

1. Smith I, Monkemuller K, Wilcox CM. Incidentally Identified Common Bile Duct Dilatation: A Systematic Review of Evaluation, Causes, and Outcome. Journal of clinical gastroenterology. 2015;49(10):810-815.
2. Malik S, Kaushik N, Khalid A, et al. EUS yield in evaluating biliary dilatation in patients with normal serum liver enzymes. Digestive diseases and sciences. 2007;52(2):508-512.
3. Oppong KW, Mitra V, Scott J, et al. Endoscopic ultrasound in patients with normal liver blood tests and unexplained dilatation of common bile duct and or pancreatic duct. Scandinavian journal of gastroenterology. 2014;49(4):473-480.
4. Songur Y, Temuçin G, Sahin B. Endoscopic ultrasonography in the evaluation of dilated common bile duct. Journal of clinical gastroenterology. 2001 ;33(4):302-305.
5. Di Serafino M, Gioioso M, Severino R, et al. Ultrasound findings in paediatric cholestasis: how to image the patient and what to look for. Journal of ultrasound. 2020;23(1):1-12.
6. Jeon J, Song SY, Lee KT, Lee KH, Bae MH, Lee JK. Clinical significance and long-term outcome of incidentally found bile duct dilatation. Digestive diseases and sciences. 2013;58(11):3293-3299.
7. Babbitt DP. [Congenital choledochal cysts: new etiological concept based on anomalous relationships of the common bile duct and pancreatic bulb]. Annales de radiologie. 1969;12(3):231-240.
8. Matsumoto Y, Uchida K, Nakase A, Honjo I. Clinicopathologic classification of congenital cystic dilatation of the common bile duct. American journal of surgery. 1977;134(5):569-574.
9. Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. The American Journal of Surgery. 1977;134(2):263-269.
10. Todani T, Watanabe Y, Toki A, Morotomi Y. Classification of congenital biliary cystic disease: special reference to type Ic and IVA cysts with primary ductal stricture. Journal of hepato-biliary-pancreatic surgery. 2003;10(5):340-344.
11. Arora A, Mukund A, Thapar S, Alam S. Anomalous Pancreaticobiliary Junction. Journal of Pediatric Gastroenterology and Nutrition. 2014;58(2).
12. Lee HC, Yeung CY, Fang SB, Jiang CB, Sheu JC, Wang NL. Biliary cysts in children–long-term follow-up in Taiwan. Journal of the Formosan Medical Association = Taiwan yi zhi. 2006;105(2):118-124.
13. Weng SC, Lee HC, Yeung CY, Chan WT, Liu HC, Jiang CB. Choledochal cyst as an important risk factor for pediatric gallstones in low-incidence populations: A single-center review. Pediatrics and neonatology. 2020;61(6):598-605.
14. Thơ TĐ. Nghiên cứu kết quả ứng dụng máy bơm nước điều khiển áp lực trong nội soi tán sỏi điện thủy lực điều trị sỏi trong gan tại bệnh viện Việt Đức. Y học Việt Nam. 2015;tháng 7(số 1):53-57.
15. Nam NH. Nghiên cứu kỹ thuật và kết quả nội soi tán và lấy sỏi đường mật qua đường hầm Kehr trong điều trị sỏi mật sót sau mổ, Trường Đại học Y Hà Nội 2006.
16. Ragot E, Mabrut JY, Ouaissi M, et al. Pancreaticobiliary Maljunctions in European Patients with Bile Duct Cysts: Results of the Multicenter Study of the French Surgical Association (AFC). World journal of surgery. 2017;41(2):538-545.
17. Soares KC, Arnaoutakis DJ, Kamel I, et al. Choledochal cysts: presentation, clinical differentiation, and management. J Am Coll Surg. 2014;219(6):1167-1180.