Nishiguchi S, Shiomi S, Sasaki N, Iwata Y, Tanaka H, Kubo S, Hirohashi K, Ochi H
Third Department of Internal Medicine, Osaka City University Medical School, Japan.
Ann Nucl Med. 2000 Oct;14(5):383-6. doi: 10.1007/BF02988702.
A 39-year-old woman with acute cholecystitis and gallstones underwent laparoscopic cholecystectomy. She suffered from recurrent episodes of cholangitis due to injury of the major bile ducts during laparoscopic cholecystectomy. Hepatobiliary scintigraphy with Tc-99m Sn-N-pyridoxyl-5-methyltryptophan was performed. Although normal bile excretion was found from the left hepatic duct to the percutaneous transhepatic biliary drainage (PTBD) tube, excretion from the right hepatic lobe was prolonged. Scintigraphy with Tc-99m diethylenetriaminepentaacetic acid-galactosyl human serum albumin demonstrated atrophy of the right hepatic lobe and enlargement of the left hepatic lobe. Cholangiography via the PTBD tube revealed complete obstruction of the left hepatico-jejunal anastomosis and could not enhance the right intrahepatic bile duct. A right hepatic lobectomy was performed because of the atrophy, glissonitis and the absence of an appropriate bile duct for reconstruction. Postoperatively she was active and exhibited no evidence of recurrent cholangitis.
一名患有急性胆囊炎和胆结石的39岁女性接受了腹腔镜胆囊切除术。她因腹腔镜胆囊切除术期间主要胆管损伤而反复发生胆管炎。进行了用锝-99m N-吡哆醛-5-甲基色氨酸的肝胆闪烁显像。尽管从左肝管到经皮经肝胆道引流（PTBD）管发现胆汁排泄正常，但右肝叶的排泄延长。用锝-99m二乙三胺五乙酸-半乳糖基人血清白蛋白进行的闪烁显像显示右肝叶萎缩和左肝叶增大。通过PTBD管进行的胆管造影显示左肝管空肠吻合完全阻塞，且右肝内胆管无法显影。由于萎缩、肝门炎以及缺乏合适的用于重建的胆管，进行了右肝叶切除术。术后她活动自如，没有复发性胆管炎的迹象。
