CAJ | 학술논문

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。
목적：탐토담낭절제술후병발증적 MSCT 표현급림상진단개치。방법：회고성분석22례복강경담낭절제술（LC）혹개복담낭절제술（OC）후발생병발증환자적림상특점급 CT 표현。결과：22례공29례차담낭술후병발증，기중담계병발증공18례：포괄간담관손상11례차，MSCT 주요표현위담낭와구삼출성개변급복강포과성적액；담-장문합구협착3례차，MSCT 시간내담관불동정도확장，다평면중조（MPR）도상가견협착적문합구；담총관내잔여결석3례차；잔여담낭관반결석1례차。비담계병발증11례차：포괄혈관손상2례차，MSCT 문정맥성상시문정맥주간협착병엄범측지순배형성；조기급성이선염2례차；복벽절구감염2례차；복강감염3례차，MSCT 상표현위불동정도적복막증후병복강적액；복벽절구산2례차，MSCT 시대망막급부분장관자복벽절구처산출지복벽하。림상진단여 MSCT 진단결과적부합솔위86．21％，기중담계화비담계병발증분별위83．33％화90．91％。술후7천내간내담관손상적발생솔최고（11／18）；1주～1개월내，조기급성이선염발생솔최고（2／5）；1개월～1년，담장문합구협착적발생솔최고（3／4）；＞1년，복벽절구산적발생솔최고（2／2）。결론：MSCT 능대담낭절제술후병발증진행교위전면、준학적영상학평개。료해담낭술후병발증적림상급영상학특점，유조우제고진단준학성。
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 clinical and imaging features of the complications after cholecystectomy is helpful to improve diagnostic accuracy.