Toyoda Junya, Sekido Hitoshi, Takeda Kazuhisa, Shimizu Tetsuya, Matsuda Goro
Department of Surgery, National Hospital Organization Yokohama Medical Center, 3-2-60, Harajuku, Totuka-Ku, Yokohama, Kanagawa, 245-8575, Japan.
Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan.
Surg Case Rep. 2019 Aug 6;5(1):127. doi: 10.1186/s40792-019-0685-7.
A drain exchange with the use of a guidewire may be accompanied by serious complications.
This case involved an 86-year-old man with overlapping cancers of intrahepatic cholangiocarcinoma and perihilar cholangiocarcinoma. A left hepatectomy, a left caudal lobectomy (with a medial hepatic vein preservation), an extrahepatic bile duct resection, and a right hepatojejunostomy were performed. The abdominal drain was placed into the hepatectomy side. Bile leakage occurred on the seventh day after the surgery, and the drain was exchanged. Since the bile leakage was still detectable via a computed tomography (CT) scan on the 15th postoperative day, the drain was exchanged again. On the next day, blood had discharged from the drain. A CT scan revealed that the tip of the drain was straying into the right atrium (RA) and the drain was removed from the inferior vena cava (IVC) under general anesthesia. One week later, a fiburin thrombus was observed from the IVC to the RA via the use of transthoracic echocardiography. A right atrial incision, a thrombus removal, and a middle hepatic vein merging section closure surgery were performed. Afterward, the patient's general condition gradually improved, and he was transferred to the hospital for rehabilitation.
More careful guidewire operations are necessary at the time of the exchange of the drain to prevent the drain from being placed too close to blood vessels.
使用导丝进行引流管更换可能会伴随严重并发症。
本病例为一名86岁男性，患有肝内胆管癌和肝门周围胆管癌重叠癌。进行了左肝切除术、左尾状叶切除术（保留肝中静脉）、肝外胆管切除术和右肝空肠吻合术。腹腔引流管置于肝切除侧。术后第7天发生胆漏，更换了引流管。由于术后第15天通过计算机断层扫描（CT）仍可检测到胆漏，再次更换了引流管。次日，引流管有血液流出。CT扫描显示引流管尖端误入右心房（RA），遂在全身麻醉下经下腔静脉（IVC）取出引流管。一周后，经胸超声心动图检查发现从下腔静脉到右心房有纤维蛋白血栓形成。进行了右心房切开、血栓清除和肝中静脉汇合部闭合手术。此后，患者的一般状况逐渐改善，并转至康复医院。
在更换引流管时，需要更谨慎地操作导丝，以防止引流管放置过靠近血管。
