胆道出血的原因诊断与治疗

目的探讨胆道出血的原因、诊断及处理方法。方法对我院收治的32例胆道出血患者的出血原因、诊断与治疗进行回顾性分析。结果 32例患者中术前出血患者21例,其中胆道结石伴感染15例,肝肿瘤2例、肝门部胆管癌2例,胆囊癌1例,肝脓肿1例;术中出血患者4例,均为胆道取石术中出血,3例为胆管壁损伤出血,1例为结石卡压致左肝内胆管左门静脉瘘出血;术后出血患者7例,其中胆总管切开取石术后4例,胆肠吻合术后1例,经皮肝穿术后2例。10例保守治疗,9例痊愈,1例死亡。5例行肝动脉血管造影与介入栓塞治疗,4例止血成功,1例失败后手术治愈。13例行手术治疗,均痊愈。4例术中出血,3例采用胆道镜直视下电凝法治疗,1例行左半肝切除治愈。结论胆道结石伴感染是胆道出血的主要原因,近年来医源性操作及创伤性胆道出血逐年增多,及时分析胆道出血的原因,做出正确的诊断,根据不同的病因,选择合适的治疗方法,可提高胆道出血的治疗效果原因。

Diagnosis and treatment of biliary tract bleeding

Objective To study the reasons of biliary tract bleeding, diagnosis and treatment methods. Methods The retro- spectively analyzed bleeding causes, diagnosis and treatment of 32 cases of biliary hemorrhage patients in our hospital. Results 21 cases of preoperative bleeding patients among 32 cases of patients, including 15 cases of biliary calculi associated with infection, 2 ca- ses of liver tumor, 2 cases of the hepatic bile duct carcinoma in porta hepatis, one case of gallbladder carcinome,one case of liver ab- scess ;4 cases of Intraoperative hemorrhage patients,cause of biliary lithotomy intraoperative hemorrhage,include 3 cases with bile duct wall injury bleeding, 1 case of the Formation of the left portal vein fistula bleedingof Left intrahepatic bile ducts by Stone of.oppression; 7 cases of postoperative bleeding,include 4 cases of bile duct incision to take stone, 1 case of Biliary intestinal anastomosis, 2 cases of percutaneous liver biopsy. 10 cases of patients by conservative treatment, 9 cases recovered, 1 case died. 5 underwent hepatic artery angiography and interventional embolization treatment, 4 cases of hemostasis, 1 case failed after surgery to cure. 13 underwent surgical treatment, all cured. 4 cases of intraoperative bleeding, 3 cases treated by electrocoagulation under choledochoscope orthophoria, 1 un- derwent left liver resection is cured. Conclusion biliary calculi associated with infection is a major cause of biliary tract bleeding, I- atrogenic operation and traumatic Hemobilia increasing in recent years , hemobilia was timely analysis of the reason, make the right diagnosis, according to different causes, choose the appropriate treatment, can improve the therapeutic effect of hemobilia.