医源性胆管树毁损的诊断与治疗  

Diagnosis and treatment of iatrogenic biliary tree destruction

作　　者：曾建平[1] 王艮 金烁 段伟东[2] 王敬[2] 刘哲[2] 董家鸿[1] Zeng Jianping;Wang Liang;Jin Shuo;Duan Weidong;Wang Jing;Liu Zhe;Dong Jiahong(Department of Hepato-pancreto-biliary Surgery,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院肝胆胰中心,102218 [2]解放军总医院肝胆外科,北京100853

出　　处：《中华消化外科杂志》2018年第7期740-745,共6页Chinese Journal of Digestive Surgery

基　　金：国家科技重大专项（2012ZX10002017-003）;北京市医院管理局“使命”计划（SML20152201）

摘　　要：目的总结医源性胆管树毁损的临床病理特征和诊断与治疗经验。方法采用回顾性横断面研究方法。收集1990年1月至2013年12月解放军总医院（9例）和2014年12月至2017年5月北京清华长庚医院（2例）收治的11例医源性胆管树毁损患者的临床资料。观察指标：（1）致伤原因和损伤部位。（2）临床表现。（3）影像学检查表现。（4）治疗情况。（5）随访情况。采用门诊和电话方式进行随访，了解患者长期预后情况。随访时间截至2018年4月。偏态分布的计量资料采用M（范围）表示。结果（1）致伤原因和损伤部位：11例医源性胆管树毁损患者的致伤原因：肝血管瘤经导管肝动脉栓塞术治疗7例，肝血管瘤经高强度聚焦超声治疗1例，假性动脉瘤栓塞治疗1例，肝包虫病硬化剂注射治疗1例，肝细胞癌的射波刀放射治疗1例。损伤部位：11例患者中，累及双侧胆管树5例，累及右侧胆管树3例，累及双侧肝门部主要胆管2例．累及左侧胆管树1例。（2）临床表现：11例医源性胆管树毁损患者均表现为反复寒战、高热，合并不同程度的黄疸。症状首次出现的时间为胆管树毁损后2周至3个月。11例患者中，7例并发不同程度的肝脓肿（4例脓肿同时累及左、右半肝，2例脓肿集巾于右半肝．1例集中于左半肝）。8例患者在病程后期继发胆汁性肝硬化、门静脉高压症、脾肿大和脾功能亢进。（3）影像学检查表现：磁共振胆胰管造影或胆道造影检查表现为坏死段胆管缺失，受损胆管树的串珠样狭窄和扩张，近端胆管分支减少，常伴有胆囊坏死。CT或MRI检查显示受损胆管树走行区域结构消失或管壁增厚，合并肝脓肿者脓肿多呈散在、多发。5例患者继发肝萎缩增生综合征，均表现为右半肝萎缩和左半肝增生。放射治疗导致的胆管树毁损具有持续进展的特点，早期仅表现为局�Objective To summarize the clinicopathological eharacteristic, diagnosis and treatment of iatrogenic biliary tree destruction. Methods The retrospective cross-sectional study was conducted. The clinical data of 11 patients with iatrogenic biliary tree destruction who were admitted to the Chinese PLA General Hospital （9 patients） between January 1990 and December 2013 and Beijing Tsinghua Changgung Hospital （2 patients） between December 2014 and May 2017 were collected. Observation indicators： （1） causes and parts of destruction; （2） clinical manifestation; （3） imaging performance; （4） treatment; （5） follow-up. Follow-up using outpatient examination and telephone interview was performed to detect long-term prognosis of patients up to April 2018. Measurement data with skewed distribution were described as M （range）. Results （1） Causes and parts of iatrogenie biliary tree destruction ： causes of iatrogenie biliary tree destruction in 11 patients ： transcatheter arterial embolization fur hepatic hemangioma was performed in 7 patients, high intensity focused ultrasound for hepatic; hemangioma in 1 patient, arterial embolization for false aneurysm in 1 patient, sclerosant injection for hepatic echinococcosis in 1 patient, and cyberknife radiotherapy for hepatocellular carcinoma in 1 patient. Parts of biliary tree destruction of 11 patients： 5, 3, 2 and 1 respectively involved bilateral biliary tree, right biliary tree, bilateral main biliary ducts in hepatic port and left biliary tree. （2） Clinical manifestation： 11 patients had symptoms of recurrent chills and fever, and combined with different degrees of jaundice. The initial symptom occurred in 2 weeks to 3 months after iatrogenic biliary tree destruction. Of 11 patients, 7 were complicated by different degrees of hepatic abscess, and abscess involving left and right half liver were detected in 4 patients, aggregating in right half liver in 2 patients and aggregating in left half liver in 1 patient. Eight patients ha

关 键 词：胆管损伤 医源性 胆管树毁损 经导管肝动脉栓塞术 肝切除术 肝移植 

分 类 号：R657.4[医药卫生—外科学]