Ectopic liver on the surface of the gallbladder
Ectopic liver on the surface of the gallbladder
复制标题
胆囊表面的异位肝脏
DOI：
10.1136/bcr-2022-251229
复制
发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Kozo Miyatani
中科院分区：
文献类型：
--
作者：
Takehiko Hanaki;Kozo Miyatani
一名60多岁的男子被诊断为急性胆囊炎，并被转诊到外科进行腹腔镜胆囊切除术。手术探查显示胆囊壁有异位肝（EL）（图1A），术前影像学未发现。使用超声血管扩张器分离EL柄，并将EL与胆囊一起取出。患者出院，无并发症，包括胆瘘。EL是一种罕见的肝脏形态学异常，几乎总是无症状，并在手术或尸检中偶然发现。EL被定义为缺乏与母肝实质的解剖学连接的肝组织，通常位于胆囊周围。1据报告，剖腹手术或腹腔镜检查时的EL发生率为0.24%至0.47%。1组织学上，在连接胆囊壁和EL的柄中可以看到胆管、门静脉和动脉结构，如本例所示（图1B）。在这里，没有恶性结果; EL可能易患肝细胞癌。Morita等报道了39例EL肝细胞癌。他们指出，肝细胞癌的肝硬化发生率明显低于一般肝癌。2据推测，其原因与它们不太容易受到周围组织压力的影响有关，这有利于细胞增殖、血管供应和胆汁排泄机制不完整。3.即使偶然发现也需要切除，因为即使没有慢性肝病也可能发生癌变。此外，当切除EL周围的结缔组织时，重要的是使用能量器械或夹子以避免胆漏，因为残留组织可能存在异常胆管交通。1
A man in his 60s was diagnosed with acute cholecystitis and referred to the surgery department for laparoscopic cholecystectomy. Operative exploration revealed an ectopic liver (EL) on the gallbladder wall (figure 1A), which was not detected by preoperative imaging. The EL stalk was dissected using an ultrasonic vessel sealer, and the EL was removed with the gallbladder. The patient was discharged with no complications, including a biliary fistula. EL is a rare morphological abnormality of the liver that is almost always asymptomatic and discovered incidentally during surgery or autopsy. EL is defined as liver tissue that lacks an anatomical connection to the mother liver parenchyma, often localised around the gallbladder. 1 EL incidence has been reported to be from 0.24% to 0.47% at laparotomy or laparoscopy. 1 Histologically, bile ducts, portal vein and arterial structures can be seen in the stalk connecting the gallbladder wall to the EL, as observed in this case (figure 1B). Here, there were no malignant findings; EL may be susceptible to hepatocellular carcinoma. Morita et al reported 39 cases of hepatocellular carcinoma in EL. They stated that the rate of cirrhosis of hepatocellular carcinoma was clearly lower than that of general hepatocarcinogenesis. 2 The reason for this has been hypothesised to be related to the fact that they are less susceptible to pressure from surrounding tissues, which favours cell proliferation and incomplete vascular supply and bile excretion mechanisms. 3 Resection would be desirable even on incidental detection since carcinogenesis may occur even in the absence of chronic liver disease. In addition, when resecting connective tissue around the EL, it is important to use energy devices or clips to avoid bile leakage since there may be abnormal bile duct traffic with the residual tissue. 1
DOI：
10.2957/kanzo.50.383
发表时间：
2009
期刊：
Kanzo
影响因子：
--
作者：
Kaori Morita;E. Mita;C. Song;T. Ohta;H. Hasegawa;Shouichi Nakazuru;T. Toyama;N. Kuzushita;Mitsuhiro Takada;M. Tsujie;A. Miyamoto;Keiji Yamamoto;S. Nakamori;Michio Kato
通讯作者：
Michio Kato
影响因子：
0.6
作者：
Martinez, Carlos Augusto Real;de Resende junior, Herminio Cabral;Palma, Rogerio Tadeu
通讯作者：
Palma, Rogerio Tadeu
DOI：
10.1097/01.meg.0000131037.92864.df
发表时间：
2004-08-01
影响因子：
2.1
作者：
Caygill, CPJ;Gatenby, PAC
通讯作者：
Gatenby, PAC