确切定位行肝切除术治疗肝内胆道出血

目的 探讨确切定位下行肝叶/段切除治疗肝内胆道出血的价值.方法 分析1998年1月至2008年10月间23例胆道出血行肝叶/段切除患者的临床资料,病因为胆道感染或伴结石14例(60.9%),外伤6例(26.1%),原发性肝癌3例(13.0%).术前经选择性肝动脉造影明确并确切定位胆道出血5例,术中胆道、肝内病灶探查确切定位胆道出血18例.行右半肝切除4例,第Ⅴ、Ⅵ肝段联合切除5例,左肝外叶切除8例,左半肝切除6例.结果 23例手术止血均获成功,无围手术期死亡病例.术后胆瘘2例,膈下脓肿1例,应激性溃疡1例,急性肾功能衰竭1例,经综合治疗后治愈.15例获随访,随访8个月～10年,3例肝癌患者均死于癌症转移、复发,2例死于肝内胆管结石复发并胆汁性肝硬化.结论 对病因明确有胆道出血相关疾病,病灶局限于一侧,定位确切,同时病人能忍受手术,应争取肝叶/段切除治疗肝内胆道出血.

Precise orientation and hepatectomy in the management of biliary tract hemorrhage

Objective To determine the method for locating the hemorrhagic site of biliary tract and assess the value of hepatectomy.Methods Clinical data of 23 patients with biliary tract hemorrhage undergoing liver segmentectomy between January 1998 and October 2008 were analyzed. There were infection of biliar tract or hepatolithiasis in 14 patients(60.9%), trauma in 6 (26.1%) and primary liver cancer in 3 (10.0%). Precise orientation was achieved by selective angiography in 5 patients and by bile duct exploration in 18. Operative approaches included left hemi-hepatectomy in 6 patients, left lateral lobectomy in 8, right hemi-hepatectomy in 4 and combined right segmentectomy in 5.Results All cases were successfully treated without any operative mortality. A majority of complications were bile leakage in 2 cases, subphrenic infection in 1, stress gastric ulcer in 1 and acute renal failure in 1. During the follow-up period of 8 months - 10 years in 15 patients, 3 died of recurrent or metastasis liver cancer and 2 biliary cirrhosis.Conclusion Hepatectomy is advocated for the management of biliary tract hemorrhage if bleeding is localized to a definite segment and the patient can tolerate the procedure.