tailieunhanh - Hepatobiliary Surgery - part 3

Hình. . Cuối giai đoạn hình ảnh. Ba tổn thương được nhìn thấy trên các luận án hai hình ảnh. Các thương tổn trong phân khúc VIII và tổn thương trong khía cạnh bên của đoạn II / III là rất thấp suy giảm và khả năng để Đại diện u nang. Khối lượng nhỏ medially trong gan trái (mũi tên) thường là một di căn. | 48 Hepatobiliary Surgery 4 Fig. . Middle phase image at the same level looks similar. The three lesions are demonstrated. Fig. . Late phase images. The three lesions are seen on these two images. The lesion in Segment VIII and the lesion in the lateral aspect of Segment II III are very low attenuation and likely to represent cysts. The small mass medially in the left liver arrows is most likely a metastasis. Interventional Radiology in Hepatobiliary Surgery 49 Fig. . Early phase image at the level of the porta. There is an area of low attenuation anteriorly in Segment IV abutting the umbilical fissure. 4 Therapeutic and Palliative Procedures Percutaneous Cholecystostomy General Considerations Percutaneous cholecystostomy PC is generally performed in patients with acute cholecystitis who are too ill to undergo cholecystectomy. The procedure is most often performed in acute acalculous cholecystitis. Acalculous cholecystitis typically occurs in elderly and or extremely ill patients frequently in the intensive care unit. Definitive diagnosis may be difficult but should be suspected in this patients in whom there is no other explanation for fever and leukocytosis or when the gallbladder is distended and tender. PC may represent definitive treatment in these patients. Given the relative ease and safety of performing PTC most interventional radiologists have a low threshold for performing this procedure in the appropriate clinic situation. PC may also be performed in cases of calculous cholecystitis in patients considered poor operative candidates. When gallstones are present the ultimate treatment depends on the clinical situation. The procedure may be temporizing in patients whose condition improves enough to allow for definitive cholecystectomy. In patients who remain poor surgical candidates stones may be removed percutaneously from the gallbladder or common bile duct and balloon sphincterotomy may be performed. Rarely PC may be performed to provide .