创伤性胆汁瘤的诊断与治疗  

Posttraumatic biloma in 46 cases

作　　者：高劲谋[1] 杨俊[1] 赵山红[1] 梁绍勇[1] 林曦[1] 艾涛[1] 

机构地区：[1]重庆市急救医疗中心创伤科,400014

出　　处：《中华普通外科杂志》2014年第7期503-506,共4页Chinese Journal of General Surgery

摘　　要：目的 探讨创伤性胆汁瘤的成因、诊断和治疗方法.方法 回顾性分析10年间肝和胆道损伤患者资料和胆汁瘤的诊治情况.结果 46例胆汁瘤中,40例发生在Ⅲ～Ⅴ级肝损伤后,胆汁瘤发生率为15.2％（40/263）.Ⅳ、Ⅴ级与Ⅲ级肝损伤胆汁瘤发生率分别为22.6％ （31/137）和7.1％ （9/126）（χ^2=12.20,P＜0.01）;钝性和穿透性肝损伤胆汁瘤发生率分别为19.3％（35/181）和6.1％ （5/82）（χ^2=7.67,P＜0.01）.46例胆汁瘤中36例发生在非手治疗后,4例出现在手术治疗后.另6例为肝外胆道损伤所致,发生率18.8％（6/32）.46例均经螺旋CT检查,9例同时行MRI;11例加做ERCP.肝损伤后胆汁瘤40例中,28例经超声或CT引导下穿刺置管引流治愈;12例＜30 cm3的胆汁瘤自行吸收.肝外胆道损伤所致6例经手术治愈.本组无死亡,亦无与胆汁瘤治疗相关的并发症.结论 非手术治疗严重肝损伤应警惕胆汁瘤发生;肝损伤后胆汁瘤优先选择超声或CT引导下穿刺置管引流,肝外胆道损伤引起者多需手术治疗.Objective To probe the causes,early recognition and effective therapy of posttraumatic biloma.Methods The data of all patients with the injury of the liver and bile duct treated in our center during the past 10 years were reviewed.Patients,diagnosed with biloma were retrospectively analyzed in respects of sex,age,cause of biloma,methods and efficacy of diagnosis and treatment.Results There were 46 patients with biloma.Of them,40 were found after liver trauma of grade Ⅲ-Ⅴ.The incidence of biloma was 15.2% （40/263）.In grade Ⅳ,Ⅴ,and Ⅲ,it was 22.6% （31/137） and 7.1% （9/126） respectively （χ^2 =12.20,P 〈 0.01） and in blunt and penetrating injury,it was 19.3% （35/181） and 6.1% （5/82） respectively （χ^2 =7.67,P 〈 0.01）.Of these 40,36 were found during the course of conservative therapy of severe liver trauma; and 4 were found after laparotomy for the liver trauma.The remaining 6 cases of biloma had a history of injury to extrahepatic bile duct with a incidence of 18.8%（6/32）.All 46 patients received spiral CT scaning plus MRI in 9,and ERCP in 11.Of those 40 with biloma after severe liver trauma,28 were cured by ultrasound-guided or computed tomography scan-guided pigtail drainage; and the remaining 12,in whom the biloma volume 〈 30 cm3 resolved spontaneously.Six patients in whom the biloma as a result of injury to extrahepatic bile duct were cured by surgical intervention.There was no death and complication related with the therapy of biloma.Conclusions Attention should be given to biloma formation,when nonoperative therapy is exercised for severe liver trauma.Ultrasound-or CT scan-guided pigtail drainage is an effective option,but those due to injury of extrahepatic bile duct require surgical intervention.

关 键 词：创伤和损伤 引流术 胆汁瘤 

分 类 号：R735.8[医药卫生—肿瘤]