Wen Feng, Dong Yue, Lu Zai Ming, Liu Zhao Yu, Li Wei, Guo Qi Yong
*Department of Radiology, Shengjing Hospital, China Medical University, Shenyang †Department of Radiology, LiaoNing Cancer Hospital, DaLian Medical University Clinical Oncology College, Shenyang, Liaoning, China.
Surg Laparosc Endosc Percutan Tech. 2016 Feb;26(1):e18-24. doi: 10.1097/SLE.0000000000000241.
To assess the imaging features and the management of hemobilia after laparoscopic cholecystectomy (LC).
A total of 12 patients who were treated for hemobilia after LC were included in the study. Selective arteriography was performed to find the bleeding artery. Coils or microcoils were deployed superselectively to occlude the bleeding branch. The clinical course, imaging findings, the embolic effect, complications, and follow-up were evaluated.
Risk factors for hemobilia included a variant ductal anatomy, a variant cystic artery, and intraoperative adhesion. Abdominal computed tomography (CT) could provide the diagnostic signs as follows: a hematocele in the abdominal cavity, the gallbladder fossa, and the bile duct, biliary dilation, pseudoaneurysm of the right hepatic artery, and contrast extravasations on contrast-enhanced CT. No rebleeding occurred after the transcatheter arterial embolization in all patients without immediate procedural complications.
Gallbladder triangle anatomic variation and intraoperative adhesion were the risk factors for hemobilia after LC. Abdominal CT is a useful examination for the diagnosis. Transcatheter arterial embolization is the therapeutic option of choice.
评估腹腔镜胆囊切除术（LC）后发生胆道出血的影像学特征及处理方法。
本研究纳入了12例LC术后发生胆道出血的患者。行选择性动脉造影以寻找出血动脉。超选择性置入弹簧圈或微弹簧圈以闭塞出血分支。对临床病程、影像学表现、栓塞效果、并发症及随访情况进行评估。
胆道出血的危险因素包括胆管解剖变异、胆囊动脉变异及术中粘连。腹部计算机断层扫描（CT）可提供如下诊断征象：腹腔、胆囊窝及胆管内积血，胆管扩张，右肝动脉假性动脉瘤，以及增强CT上的造影剂外渗。所有患者经导管动脉栓塞术后均未再出血，且无即刻手术并发症。
胆囊三角解剖变异及术中粘连是LC术后胆道出血的危险因素。腹部CT对诊断有帮助。经导管动脉栓塞是首选的治疗方法。
