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  • 章建全,刁宗平,盛建国,张航,傅志仁.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[J].第二军医大学学报,2020,41(3):345-348    [点击复制]
  • ZHANG Jian-quan,DIAO Zong-ping,SHENG Jian-guo,ZHANG Hang,FU Zhi-ren.Fatal danger caused by catheterization treatment for portal vein pseudoaneurysm misdiagnosed as gallbladder forssa abscess: a case report[J].Acad J Sec Mil Med Univ,2020,41(3):345-348   [点击复制]
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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
章建全1*,刁宗平1,盛建国1,张航1,傅志仁2
0
(1. 海军军医大学(第二军医大学)长征医院超声诊疗科, 上海 200003;
2. 海军军医大学(第二军医大学)长征医院肝移植中心, 上海 200003
*通信作者)
摘要:
肝脏门静脉瘤比较少见,并发于腹腔镜下胆囊切除术的假性门静脉瘤更为少见。当依据患者临床症状和影像学检查将假性门静脉瘤误判为术后胆囊窝脓肿时,临床上极易作出对“脓肿”实施穿刺引流的治疗决策,此举陡增穿刺出血风险。本文报道1例因此情形行发生出血时的成功抢救经验,并对该患者腹腔镜胆囊切除术后形成假性门静脉瘤的可能机制、假性门静脉瘤超声影像和核磁共振成像误诊的原因进行剖析。
关键词:  腹腔镜胆囊切除术  假性门静脉瘤  脓肿  置管引流  超声造影
DOI:10.16781/j.0258-879x.2020.03.0345
投稿时间:2019-03-07修订日期:2019-09-17
基金项目:
Fatal danger caused by catheterization treatment for portal vein pseudoaneurysm misdiagnosed as gallbladder forssa abscess: a case report
ZHANG Jian-quan1*,DIAO Zong-ping1,SHENG Jian-guo1,ZHANG Hang1,FU Zhi-ren2
(1. Department of Ultrasound, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China;
2. Organ Transplantation Center, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China
*Corresponding author)
Abstract:
Portal vein aneurysms (PVA) are a rare vascular anomaly of the portal system, Pseudoportal vein aneurysms complicated to laparoscopic cholecystectomy(LC) are much less encountered. If a pseudoportal vein aneurysm was misdiagnosed as a focal abscess at gallbladder fossa on base of the clinical manifestations and imaging findings after LC, it is readily for the surgeon to make a therapeutic decision to take ultrasound-guided catheterization and drainage against the gallbladder fossa abscess, however, which can cause a life-threatening bleeding. In this paper, we reported the experience of successful rescue of one patient who faced life-threatening bleeding from a pseudoportal vein aneurysm, which was complicated to a laparoscopic cholecystectomy procedure and was managed by ultrasound-guided puncture and drainage treatment. We described the possible mechanism of the formation of pseudoportal vein aneurysm after laparoscopic cholecystectomy and the causes of misdiagnosis of pseudoportal vein aneurysm by ultrasonography and MRI. We also intend to share our experience how to appropriately manage the emergency in face of bleeding while the aneurysm has been punctured.
Key words:  laparoscopic cholecystectomy  portal vein pseudoaneurysm  abscess  drainage  contrast-enhanced ultrasonography