Gama-Odrigues J, Bresciani C, Seid V E
Department of Gastroenterology, University of São Paulo Medical School, Brazil.
Surg Laparosc Endosc Percutan Tech. 2001 Apr;11(2):134-8.
Percutaneous liver biopsy is a routine procedure in the diagnosis, management, and follow-up of several liver disorders. Mortality and morbidity rates from percutaneous liver biopsy are low. This report of three cases of serious percutaneous liver biopsy complication and their management highlights the role played by videolaparoscopy as a diagnostic and therapeutic procedure in two different types of PLB complication: hemobilia and bile peritonitis. In two patients, intrahepatic arteriobiliary fistula developed with gastrointestinal hemorrhage (hemobilia). Both were treated with cholecystectomy and ligation of the right branch of the hepatic artery. In the third case, the percutaneous liver biopsy needle punctured the gallbladder, leading to bile peritonitis and acute abdomen, and the patient underwent videolaparoscopic cholecystectomy with aspiration and lavage of the abdominal cavity. Videolaparoscopic procedures are an adequate alternative for the management of serious percutaneous liver biopsy complications such as hemobilia and bile peritonitis. The advantages of a videolaparoscopy include low morbidity rates, quick recovery, good cosmetic result, and ability to resolve the complications of percutaneous liver biopsy.
经皮肝穿刺活检是诊断、治疗和随访多种肝脏疾病的常规操作。经皮肝穿刺活检的死亡率和发病率较低。本报告介绍了3例严重经皮肝穿刺活检并发症及其处理情况，突出了电视腹腔镜检查在两种不同类型的经皮肝穿刺活检并发症（胆道出血和胆汁性腹膜炎）中作为诊断和治疗手段所发挥的作用。2例患者发生肝内动-胆管瘘并伴有胃肠道出血（胆道出血），均接受了胆囊切除术和肝动脉右支结扎术。第3例中，经皮肝穿刺活检针穿刺了胆囊，导致胆汁性腹膜炎和急腹症，该患者接受了电视腹腔镜胆囊切除术，并对腹腔进行了抽吸和灌洗。电视腹腔镜手术是处理胆道出血和胆汁性腹膜炎等严重经皮肝穿刺活检并发症的合适替代方法。电视腹腔镜检查的优点包括发病率低、恢复快、美容效果好以及能够解决经皮肝穿刺活检的并发症。
