胆囊术后并发症的临床和多层螺旋CT分析  

Complications after laparoscopic or open cholecystectomy:clinical and MSCT features

作　　者：朱静芬[1] 黄仁军[1] 付婷婷[1] 郭亮[1] 李勇刚[1] 

机构地区：[1]苏州大学附属第一医院放射科,江苏215006

出　　处：《放射学实践》2014年第12期1456-1460,共5页Radiologic Practice

基　　金：国家自然科学基金项目(81171394);江苏省自然科学基金项目(BK2011307)

摘　　要：目的：探讨胆囊切除术后并发症的 MSCT 表现及临床诊断价值。方法：回顾性分析22例腹腔镜胆囊切除术（LC）或开腹胆囊切除术（OC）后发生并发症患者的临床特点及 CT 表现。结果：22例共29例次胆囊术后并发症，其中胆系并发症共18例：包括肝胆管损伤11例次，MSCT 主要表现为胆囊窝区渗出性改变及腹腔包裹性积液；胆-肠吻合口狭窄3例次，MSCT 示肝内胆管不同程度扩张，多平面重组（MPR）图上可见狭窄的吻合口；胆总管内残余结石3例次；残余胆囊管伴结石1例次。非胆系并发症11例次：包括血管损伤2例次，MSCT 门静脉成像示门静脉主干狭窄并广泛侧支循环形成；早期急性胰腺炎2例次；腹壁切口感染2例次；腹腔感染3例次，MSCT 上表现为不同程度的腹膜增厚并腹腔积液；腹壁切口疝2例次，MSCT 示大网膜及部分肠管自腹壁切口处疝出至腹壁下。临床诊断与 MSCT 诊断结果的符合率为86．21％，其中胆系和非胆系并发症分别为83．33％和90．91％。术后7天内肝内胆管损伤的发生率最高（11／18）；1周～1个月内，早期急性胰腺炎发生率最高（2／5）；1个月～1年，胆肠吻合口狭窄的发生率最高（3／4）；＞1年，腹壁切口疝的发生率最高（2／2）。结论：MSCT 能对胆囊切除术后并发症进行较为全面、准确的影像学评价。了解胆囊术后并发症的临床及影像学特点，有助于提高诊断准确性。Objectire：To investigate the MSCT characteristics of complications following cholecystectomy and diag-nostic value of MSCT.Methods：The clinical and MSCT dada of 22 patients with complications following laparoscopic chole-cystectomy （LC）and open cholecystectomy （OC）were collected and analyzed retrospectively.Results：Of 22 patients,29 complications were observed,including 18 cases of biliary complications （BC group）and 11 cases of non-biliary complica-tions （NBC group）.In BC group,intrahepatic bile duct injury was observed in 11 cases,with free or encapsulated intrape-ritoneal fluid and effusion in the gallbladder fossa demonstrated on MSCT;intra-hepatic bile duct dilation was showed in 3 cases with cholangio-intestinal anastomotic stricture,which was clearly demonstrated on multiplanar reformation images;re-sidual cholecystic stones,residual stones in common bile duct were found in 1 and 3 cases respectively.In NBC group,there were vascular complications in 2 cases,including portal vein injury and superior mesenteric artery embolism;acute pancreati-tis in 2 cases;abdominal infection in 3 cases;infection of incisional wound in 2 cases.incisional hernia of abdominal wall in 2 cases,which showed omentum or a loop of small bowel protruding from the abdominal incision on CT images.The coinci-dence rate of clinical diagnosis and MSCT findings of complications following cholecystectomy was 86.21%,with 83.33%and 90.91% for biliary and non-biliary complications respectively.In addition,different complications should be first consi-dered at different time after OC and LC：intrahepatic duct injury （11/18）occured mostly within 7 days after surgery;acute pancreatitis of early stage （2/5）,1 week to 1 month after surgery;biliary-intestinal anastomotic stenosis,1 month to 1 year;hernia of abdominal wall incision （2/2）,more than 1 year.Conclusion：MSCT may be a valuable method for comprehensive and accurate diagnosis of various complications after cholecystectomy.Comprehensive understanding of c

关 键 词：术后并发症 胆囊疾病 胆管 腹部手术 体层摄影术 X 线计算机 诊断 

分 类 号：R657.4[医药卫生—外科学] R816.5[医药卫生—临床医学]