假性门静脉瘤误诊为胆囊窝脓肿致穿刺引流治疗陷入致命危险1例报告

1病例资料患者女,77岁,2012年4月27日因“胆囊结石”于我院普通外科行全身麻醉下腹腔镜胆囊切除术。术中见胆囊大小约90 mm×40 mm×40 mm,与邻近大网膜粘连,胆囊壁未明显增厚、无明显水肿;清晰显露胆囊动脉前后支,用Hem-o-lok夹分别夹闭后予以切断;在距胆总管5 mm处用Hem-o-lok夹夹闭胆囊管后予以切断;胆囊剥离后对胆囊床彻底电凝止血;术中观察胆囊床及术野无渗血、渗胆汁,未留置腹腔引流条。手术过程顺利,术后恢复良好,2012年5月1日出院。

Stent placement is effective on both postoperative hepatic arterial pseudoaneurysm and subsequent portal vein stricture:A case report

To treat postoperative bleeding after hepato-pancreato-biliary surgery, interventional radiology has become essential. We report a case of coincidental pseudoan-eurysm and jejunal varices that were both successfully treated by stent-grafts. After a pancreaticoduodenec-tomy, the patient developed a pseudoaneurysm in the hepatic artery and a stenosis in its periphery. After establishing hepatic arterial flow by placing stent-grafts over both the pseudoaneurysm and the stenosis, the pseudoaneurysm was embolized with microcoils. Nine months later, the patient developed jejunal varices caused by a severe stricture in the main trunk of the portal vein. Percutaneous transhepatic portography was performed and stent-grafts were placed over the stenotic segment. A venoplasty using stent-grafts nor-malized the portal blood flow and the jejunal varices vanished. Although stenosis occurred due to scarred tissues from leakage after pancreaticoduodenectomy, stent-grafts were useful for managing jejunal bleeding post-operatively.