单中心早期开展腹腔镜胰十二指肠切除术后肝脓肿四例诊疗分析

Clinical analysis of 4 cases of liver abscess after laparoscopic pancreaticoduodenectomy at early stage in single center

目的分析单中心早期开展腹腔镜胰十二指肠切除术(LPD)后肝脓肿(LA)的病因及诊治经验。方法2017年1月~2021年1月我院接受LPD后继发肝脓肿病人4例,收集其临床资料,分析病因及治疗方法。结果4例均系LPD后继发肝脓肿。例1为术中损伤肝右动脉主干分支;例2系肝右动脉起源自肠系膜上动脉,术中误损伤结扎;例3系肠系膜上静脉楔形切除术后狭窄;例4系反复胆道逆行感染。4例均经抗生素治疗联合介入治疗后痊愈。例1术后16个月因肝脏多发转移、腹水死亡;例2术后已健康存活19个月,无复发转移;例3术后26个月因肝脏多发转移、胰头区淋巴结转移死亡;例4术后13个月因反复胆道逆行感染死亡。结论LPD后肝脓肿主要与肝脏供血动静脉损伤以及反复胆道逆行感染有关。合理使用抗生素联合介入治疗是首选的治疗方法。

Objective To analyze the etiology,diagnosis and treatment of liver abscess(LPA)after laparoscopic pancreaticoduodenectomy(LPD)in single center.Methods From January 2017 to January 2021,4 patients with secondary liver abscess who received LPD in the Second Department of General Surgery of Handan Central Hospital were collected,and their clinical data were collected to analyze the etiology and treatment of liver abscess.Results All the 4 cases were secondary liver abscess after LPD.The etiology was retrospectively analyzed according to medical records and imaging data.Case 1 was the main branch of right hepatic artery injured during operation.The right hepatic artery in case 2 originated from superior mesenteric artery and was accidentally injured and ligation during operation.The superior mesenteric vein was narrowed after wedge resection in case 3.Case 4 was a case of recurrent biliary retrograde infection.All 4 cases recovered after antibiotic therapy combined with interventional therapy.Case 1 died 16 months after surgery due to multiple liver metastases and ascites.Patient 2 survived healthy for 19 months after LPD without recurrence and metastasis.Case 3 died of jaundice 26 months after surgery due to multiple liver metastases and lymph node metastasis in the pancreatic head region.Patient 4 died of recurrent retrograde biliary tract infection 13 months after surgery.Conclusion Liver abscess after LPD is mainly related to hepatic artery and vein injury and recurrent biliary tract retrograde infection.Rational antibiotic use combined with interventional therapy is the preferred effective treatment.