췌십이지장절제술 후 발생한 간 외분절의 의인성 손상

Abstract

Purpose: To investigate the incidence, predisposing factors and image features of iatrogenically-induced focal parenchymal changes in the lateral segment of the liver after a pancreatoduodenectomy.

Materials and Methods: A follow-up CT taken on the seventh day after an uneventful pancreatoduodenectomy were retrospectively reviewed for 123 patients for newly developed focal hepatic lesions. The location, size, and shape of the lesions were analyzed along with preoperative anatomic variation of the hepatic artery, for the degree of intrahepatic bile duct dilatation and procedure duration.

Results: Other than two patients with hepatic metastases, 13 (10.6%) patients showed newly developed irregular (n = 9), linear (n = 2) or wedge-like (n = 2) hypovascular areas (1.4-8.5 cm; mean, 2.8 cm) in the posterior subcapsular portion of the lateral segment. There were only two patients (15.4%) with an aberrant origin of the segmental hepatic artery from the left gastric artery, and the degree of bile duct dilatation was nonspecific for the 13 subjected patients. Mean procedure time was not significantly different between the subjected patients and the others (541 min vs. 507 min; p = 0.160).

Conclusion: Focal iatrogenic injury in the lateral segment after a pancreatoduodenectomy would not be a common event regardless of preoperative vascular anatomic variation, bile duct dilatation, or procedure duration.