Antico E, Candelari R, Centini G, Dini L, Sartelli M, Scibè R, Sequini W
Azienda Ospedaliera Umberto I, Ancona.
Radiol Med. 1998 May;95(5):481-5.
We investigated the efficacy of interventional radiology procedures in some patients with iatrogenic injuries of the biliary tree from laparoscopic cholecystectomy.
In the last two years, 8 patients with complications of laparoscopic cholecystectomy were treated in the Department of Radiology of Umberto I Hospital, Ancona, Italy. Five of them had a subhepatic biliary collection due to a cystic duct stump leak, 2 has a leak of the Roux-en-Y hepaticojejunostomy (from a iatrogenic injury of the common biliary duct) and 1 had a right hepatic biliary duct stricture from a clip. In the patients with a cystic duct stump leak, we treated the biloma with percutaneous catheter drainage and the endoscopist positioned a nasobiliary tube, while a percutaneous abdominal catheter was positioned to drain the biloma and a percutaneous transhepatic catheter was positioned through the biliary duct tract or through the hepaticojejunostomy.
All injuries were completely repaired within 5-8 weeks of the procedure. There were no maneuver-related complications. All patients had normal serum levels of bilirubin, alkaline phosphatase and transaminase at the monthly follow-up tests performed for 3 months. US and MR cholangiopancreatography at 3 months excluded strictures, fistulas or bilomas of the biliary tree.
The prompt detection of the injuries is essential to the success of interventional radiology procedures: the patients are less debilitated, small caliber catheters can be used and recovery is quicker. The combined effort of surgeons, endoscopists and radiologists is necessary to optimize the management of patients with laparoscopic cholecystectomy-related biliary complications.
We obtained positive results with minimally invasive procedures costing less than another operation. Thus, we suggest that interventional radiology procedures become the method of choice in patients with iatrogenic injuries of the biliary tree after laparoscopic cholecystectomy.
我们研究了介入放射学方法对部分因腹腔镜胆囊切除术导致医源性胆道损伤患者的疗效。
在过去两年中，意大利安科纳翁贝托一世医院放射科对8例腹腔镜胆囊切除术并发症患者进行了治疗。其中5例因胆囊管残端渗漏出现肝下胆汁积聚，2例因医源性胆总管损伤导致Roux-en-Y肝空肠吻合口渗漏，1例因夹子导致右肝胆管狭窄。对于胆囊管残端渗漏的患者，我们采用经皮导管引流治疗胆汁瘤，内镜医师放置鼻胆管，同时放置经皮腹腔导管引流胆汁瘤，并经胆管或肝空肠吻合口放置经皮肝导管。
所有损伤在手术后5 - 8周内完全修复。未出现与操作相关的并发症。在为期3个月的每月随访检查中，所有患者的血清胆红素、碱性磷酸酶和转氨酶水平均正常。3个月时的超声和磁共振胰胆管造影排除了胆道树的狭窄、瘘管或胆汁瘤。
及时发现损伤对于介入放射学方法的成功至关重要：患者身体衰弱程度较低，可以使用小口径导管，恢复更快。外科医生、内镜医师和放射科医生的共同努力对于优化腹腔镜胆囊切除术相关胆道并发症患者的管理是必要的。
我们通过微创方法取得了积极成果，且成本低于再次手术。因此，我们建议介入放射学方法成为腹腔镜胆囊切除术后医源性胆道损伤患者的首选治疗方法。
