肝破裂并胆管损伤20例手术治疗  

Surgical treatment for hepatic rupture complicated with biliary duct injury：a retrospective analysis of 20 cases

作　　者：陈德烽[1] 陈宇峰[1] 韩明瑞[1] 郭钟容[1] 

机构地区：[1]福建医科大学附属漳州市医院肝胆外科,363000

出　　处：《临床外科杂志》2014年第6期405-406,共2页Journal of Clinical Surgery

摘　　要：目的：探讨肝破裂并胆管损伤的手术治疗。方法对我院2009年1月至2013年8月治疗的20例肝破裂并胆管损伤的病例资料进行回顾性总结分析。19例行肝毁损切除术，1例行肝脏清创修补术。胆管损伤均同时修复后T管引流。结果无围手术期死亡，术后胆瘘1例；胆道出血1例，是右肝动脉右后支的假性动脉瘤破裂引起，予肝动脉栓塞止血。结论非手术治疗期间高度怀疑肝破裂并胆管损伤时，尽早手术是抢救的最好方法。可行肝脏破裂修补术，或肝脏切除术，同时修复胆管损伤并放置T管，一旦发生胆道出血首先采用肝动脉栓塞止血。Objective To investigate the surgical treatment for hepatic rupture complicated with biliary duct injury.Method The clinical data of 20 patients with hepatic rupture and biliary duct injury from January 2009 to August 2013 were retrospectively analyzed.There were 19 cases of hepatic resection and 1 case of debridement and neoplasty.Injury of the bile duct was simultaneously repaired and drained with the T tube.Result There were no perioperative death.Postoperative biliary fistula occurred in 1 case.Hemobilia occurred in 1 case and it＇s caused by the rupture of pseudoaneurysm,which located at the right posterior branch of right hepatic artery.The bleeding was stopped by hepatic arterial embolization. Conclusion For highly suspected hepatic rupture complicated with biliary duct injury during the nonoper-ative management,early surgery is the best solution.Hepatic repair or resection should be operated and bile duct injury should be simultaneously repaired and drained with the T tube.Once the hemobilia occurs,he-patic arterial embolization can be adopted as the first choice.

关 键 词：肝破裂 胆管损伤 

分 类 号：R657.3[医药卫生—外科学]