肝胆管结石伴胆道出血51例原因分析及处理方法  

Causes and Management of Hepatolithiasis Complicate by Hemobilia:A clinical report of 51 cases

作　　者：屈顺喜[1] 付庆江[1] 李英俊[1] 曹立瀛[1] 刘四清[1] 梁家明[1] 刘希宁[1] 吴志宇[1] 董浩[1] 

机构地区：[1]华北煤炭医学院附属开滦医院,河北省唐山市063000

出　　处：《中国全科医学》2009年第11期994-995,共2页Chinese General Practice

摘　　要：目的探讨肝胆管结石患者胆道出血的原因及处理方法。方法回顾性分析我院收治的51例肝胆管结石伴胆道出血患者的出血原因,总结其治疗方法。结果51例患者中,16例为术前出血患者,其中胆总管结石、胆囊结石6例(其中5例行EST网篮取石),严重胆管炎症及胰腺炎6例,细菌性肝脓肿4例;35例为胆道术后出血患者,其中胆总管切开取石术后32例,胆肠吻合术后2例,肝切除术后1例。10例患者经保守治疗后9例痊愈,1例死亡;32例行肝动脉血管造影与介入栓塞治疗,29例止血成功,2例再次出血后行手术治愈,1例死亡;11例(包括2例介入治疗无效者)行手术治疗,均痊愈。结论胆道出血患者多合并肝内外胆管结石。应迅速分析胆道出血的原因及部位,结合出血量来选择治疗手段。在条件允许的情况下,肝动脉血管造影与栓塞是术后胆道出血诊治的首选方法,而合理地选择手术时机是提高疗效的关键。Objective To investigate the cause of the hemobilia in patients with hepatolithiasis and its treatment.Methods The data of 51 patients with hemobilia were retrospectively analyzed to find the causes and to summarize the treatment.Results In all the 56 patients,16 had pre-operative hemobilia,of which 6 got choledocholithiasis or cholelithiasis(among them 5 patients received basket extraction with endoscopic sphincterotomy),6 patients had severe cholangititis or pancreatitis,and 4 patients had bacillary liver abscess.35 patients had post-operative hemobilia,of which 32 patients had got choledocholithotomy,2 patients got biliary intestinal anastomosis,and one got hepatectomy.Among 10 patients treated by conservative therapy 9 cases were cured and one case died.Among 32 patients treated by hepatic artery angiography and interventional embolization 29 cases were successful in hemostasis,2 cases had hemobilia again and cured by operation,and one case died.All 11 patients(including 2 cases who did not respond to intervention) who received surgical therapy recovered.Conclusion Most of the patients with hemobilia have a complication of intrahepatic or extrahepatic biliary calculi.The therapy should be chosen based on promptly analyzing the causes and location of hemabilia and combining with amount of hemorrhage.If the condition allowed,the first choice for post-operative hemobilia should be hepatic artery angiography and interventional embolization,and the key to raise the effect is reasonably choosing operative opportunity.

关 键 词：胆道出血 结石 综合疗法 

分 类 号：R575.7[医药卫生—消化系统]