肝胆外科手术中胆管大出血的临床研究

目的探讨肝胆外科术中胆管大出血的常见病因及有效处理方法。方法选取15例肝胆外科手术中胆管大出血的患者，采用胆道造影、选择性肝动脉造影、纤维胆道镜等检查方法，对出血部位及出血量等进行准确评估，选择合适的手术方式进行处理，并统计其临床治疗效果。结果本组病例出血原因分别为探查致胆管狭窄部撕裂4例（26．7％）、取石致胆管壁裂伤3例（20．0％）、胆管结石伴广泛炎症4例（26．7％）、胆管动脉瘘2例（13．3％）、及肝脓肿2例（13.3％）。根据患者的出血位置、出血量、出血原因等情况给予相应的个体化治疗后均达到止血目的。结论肝胆外科术中胆管大小血有多种因素，手术过程中应进行缜密检查，根据患者具体情况对症采取相应的处理方法．以获得理想的止血效果。

Clinical study of intraoperative bile duct bleeding in Department of Hepatobiliary Surgery

Objective To explore the effective treatment method and common causes of Department of Hepatobiliary surgery bile duct bleeding. Methods Fifteen patients with bile duct Department of Hepatobiliary Surgery operation hemorrhage were selected, cholangiography, selective hepatic artery angiography, choledochofiberscope inspection method were used, the bleeding position and volume was accurately evaluated, suitable operation method for processing, and its clinical effect was analyzed. Results The patients＂ cause of hemorrhage were 4 cases （26.7%） of bile duct stricture of tear to probe, 3 cases （20.0%） of bile duct laceration stone, bile duct stones with extensive inflammation in 4 cases （26.7%）, bile duct artery fistula in 2 cases （13.3%）, and 2 cases （13.3%） of liver abscess. According to the situation of treatment of bleeding in patients with hemorrhagic quantity, location, etc. individual corresponding was given, then all reached the purpose of hemostasis. Conclusion Biliary Department of Hepatobiliary Surgery intraoperative hemorrhage and a variety of factors, should be careful to check the process of operation, adopt corresponding treatment methods according to the specific situation of patients with symptomatic, with hemostatic effect to obtain ideal.