摘要
目的探讨创伤性胆道出血的病因、诊断及防治.方法复习15年间肝外伤病人资料,对有胆道出血记录者作回顾性分析.结果 41例占同期肝外伤的8.80%.男37例,女4例.年龄16～79岁.钝性伤34例,穿透性伤7例.发生在非手术治疗肝外伤22例,肝外伤手术前3例和手术后16例.出血量200～1 800 ml;休克率68.29%.均经影像学诊断证实.除6例选择性肝动脉造影和栓塞,手术止血包括3例选择性肝动脉结扎、6例肝切除,3例经'T'管灌注止血药;其余一般治疗.6例并发症包括胆、胰瘘,膈下脓肿和胆囊缺血坏死,均治愈.2例(4.88%)死于多发伤.结论对本病认识应加强.休克不是肝动脉造影和栓塞的禁忌证,建议用永久性栓塞材料.手术主要为肝动脉结扎或肝切除,后者针对栓塞失败或胆管静脉瘘.
Objective To investigate the etiology and management of traumatic hemobilia.Methods The data of all patients with liver trauma treated in our center during the past 15 years were reviewed. Amongst these patients, those with hemobilia that had been recorded were retrospectively analyzed in respects of sex, age, cause of injury, time of hemobilia attack after the injury, grade of liver trauma by AAST, associated injuries, symptoms related to hemobilia and hemodynamics, volume and length of hemobilia, methods and efficacy of diagnosis and treatment, complications and factors of death. Statistical analysis was made for the incidence etc. Results Forty-one （8.08%） patients had hemobilia. Of these 41 patients with a mean age of 34.27 years （16-79 years）, 37 were male and 4 female. For these 41 patients, 34 suffered from blunt injuries and 7 from stab penetrating injuries. Hemobilia occurred during the nonoperative treatment in 22 patients, preoperatively in 3 and postoperatively in 16, respectively. The volume of hemobilia ranged from 200 ml to 1800 ml. Hemorrhagic shock appeared in 28 patients （68. 29%）. The diagnosis of hemobilia was proved by CT scanning and selective hepatic arterial angiography etc. For management of hemobilia, surgical intervention was carried out in 12 patients, including selective hepatic arterial ligation in 3, hepatectomy in 6 and choledochostomy followed by lavage with vasoconstrictor and coagulant through T tube in 3. Of the 29 nonoperatively treated patients, 6 received angioembolization and the other 23 simple therapy. Six patients had postoperative complications including biliary fistulae, pancreatic fistulae, subphrenic abscess and gallbladder ischemia and all the 6 patients were cured. Two patients died of polytrauma and the mortality was 4. 88% （2/41）. Conclusions Early recognition and management of hemobilia should be emphasized. Angioembolization can be safely used even if the patients have somewhat shock state. Meanwhile, steel microcoil maybe preferable. Hepatic arterial ligation and hepatectomy are selected when surgical intervention is necessary. Hepatectomy is a wise choice for management of bili-venous fistula or failure of angioembolization.
出处
《中华肝胆外科杂志》
CAS
CSCD
2005年第7期464-466,共3页
Chinese Journal of Hepatobiliary Surgery
