Radiologic Diagnosis and Non-Operative Management of Post-Cholecystectomy Major Complications

膽囊切除術術後併發症的放射線診斷與非手術治療法

蔡建中(Chien-Chung Tsai) ； 牟聯瑞(Lein-Ray Mo) ； 楊志宗(Chih-Tzung Yang) ； 葉永祥(Yung-Hsiang Yeh) ； 郭振源(Jenn-Yuan Kuo) ； 林瑞昌(Ruey-Chang Lin) ； 張國寬(Kuo-Kuan Chang) ； 樂聖高(Sheng-Kao Yueh) ； 丘文斌(Man-Pun Yau) ； 林逸文(Yie-Wen Lin) ； 黃明和(Mi)

《中華放射線醫學雜誌》 19卷4期 (1994/12) Pp. 307-317

摘要

將各種診斷及介入性放射線學步驟應用在26位接受膽囊切除術的病人產生之併發症上（7位以傳統開腹方式，19位用腹腔鏡方法），其中兩位為右肝動脈瘤，一位膽囊動脈出血，三位膽道狹窄，兩位肝管橫切，五位膽汁溢出，兩位肝管結紮，五位肝下膿瘍，六位總膽管結石殘餘。
以線圈彈簧栓及止血塊做高度選擇性經動脈栓塞成功地治療三位病人，另六位殘餘總膽管結石的病人則接受內視鏡括約肌切除術併取石網取石的治療；所有膽道狹窄的病人則利用氣球擴張術，經過5-16個月的追蹤治療後，已無任何膽道阻塞的症狀；膽汁溢出的診斷主要是靠內視鏡逆行性膽胰攝影術或經皮穿肝膽道攝影術，然後進行治療性的內視鏡膽道引流及經皮穿肝膽道引流術；經皮作膿瘍引流的有三位；在二位肝管橫切的病人中，一位接受保守性的經皮穿肝膽道引流術來舒解敗血症，另一位則於外科手術後因敗血症死亡；以上這些治療方式能使病人於確定接受外科手術前，先接受併發症的治療，避免再次的手術，或可免除敗血症及阻塞的發生。

關鍵字

膽道，介入性程序 ； 膽囊，手術 ； 手術，併發症

並列摘要

Various diagnostic and therapeutic radiologic procedures were encountered in 26 patients who suffered major complications from cholecystectomy (open method N=7, laparoscopic approach N=19). Specific lesions were pseudoaneurysm of the right hepatic artery (n=2), bleeding from the cystic artery (n=1), ductal strictures (n=3), hepatic duct transection (n=2), bile leakage (n=5), hepatic duct ligation (n=2), subhepatic abscess (n=5) and retained common bile duct stones (n=6). Superselective transarterial embolization using coil spring and gelfoam cubes was successfully performed in three patients, while six patients with retained common bile duct stones were treated with endoscopic sphincterotomy and basket stone extraction. All patients with ductal strictures had successful balloon dilatation, and were free from clinical signs of ductal obstruction after 5-16 months follow-up. Definite diagnosis of bile leaks could only be demonstrated by either Endoscopic Retrograde Cholangiopancreatography (ERCP) or Percutaneous Transhepatic Cholangiogram (PTC), and therapeutic endoscopic biliary drainage and percutaneous biliary drainage were performed respectively for bile diversion.Percutaneous abscess drainage was done in three patients. In cases of hepatic duct transection, one patient received palliative percutaneous biliary drainage to relieve the sepsis, while the other died of sepsis after operation. These therapeutic interventions either cured the complications and obviated reoperation, or relieved sepsis and obstruction before definitive surgical procedures were applied.

並列關鍵字

Bile ducts, interventional procedure ； gallbladder, surgery ； surgery, complications