vanSonnenberg E, D'Agostino H B, Easter D W, Sanchez R B, Christensen R A, Kerlan R K, Moossa A R
Department of Radiology, University of California, San Diego 92103.
Radiology. 1993 Aug;188(2):399-404. doi: 10.1148/radiology.188.2.8327685.
The authors describe their experience in management of bile duct injuries (n = 11), bile leaks or abscesses (n = 11), and bleeding (n = 1) as complications of laparoscopic cholecystectomy in 21 patients. Clinical presentations included jaundice, sepsis, pain, abdominal distention, and persistent gallstones. Twelve patients underwent operative cholangiography, three underwent conversion to open cholecystectomy, and 12 reoperations were performed in nine patients before interventional radiologic procedures, which included diagnostic percutaneous transhepatic cholangiography (n = 13), percutaneous biliary drainage (PBD) (n = 13), percutaneous stricture dilation (n = 3), stent insertion (n = 1), percutaneous abscess or biloma drainage (n = 19), and gallstone removal (n = 1). Each procedure was technically successful. Clinical improvement occurred in 18 of 19 patients. PBD was used as an operative guide before reconstructive surgery in two patients. Reoperation was unnecessary in 10 of 21 patients (48%). One patient died of fungal sepsis and pulmonary complications. This radiologic-surgical approach provided rapid and safe management of these complications.
作者描述了他们在处理21例患者腹腔镜胆囊切除术后并发症时的经验，这些并发症包括胆管损伤（11例）、胆漏或脓肿（11例）以及出血（1例）。临床表现包括黄疸、脓毒症、疼痛、腹胀和残留胆结石。12例患者接受了术中胆管造影，3例中转开腹胆囊切除术，9例患者在接受介入放射学检查前进行了12次再次手术，介入放射学检查包括诊断性经皮肝穿刺胆管造影（13例）、经皮胆道引流（PBD，13例）、经皮狭窄扩张（3例）、支架置入（1例）、经皮脓肿或胆汁瘤引流（19例）以及取石（1例）。每项操作在技术上均获成功。19例患者中有18例临床症状改善。2例患者在重建手术前将PBD用作手术引导。21例患者中有10例（48%）无需再次手术。1例患者死于真菌性脓毒症和肺部并发症。这种放射学-外科联合方法为这些并发症提供了快速且安全的处理方式。
