胆道术后胆道大出血的诊断与治疗

本文报告７３例胆道术后胆道大出血。出血原因有胆道感染及胆残石并感染５６例，胆道蛔虫７例，术中处理不当和胆道引流管压迫各４例，胆管癌术后２例。出血发生在肝内胆管５１例，肝外胆管２０例，胆肠吻合口２例。作者分析了术后胆道出血的特点，认为Ｂ超、胆道引流管和肝动脉造影能了解部分病人的出血原因和部位。原发病灶的手术发现，手术经过及出血时和出血后胆道镜检查对协助诊断也有重要的意义。本组非手术治愈２８例，手术治愈３２例。强调术后大出血的治疗应根据出血的原因、出血量、全身情况及出血周期不同而决定。

DIAGNOSIS AND TREATMENT OF MASSIVE HEMOBILIA AFTERBILIARY SURGERY

3 cases with massive hemobilia following biliary surgery are reported. Thecause of bleeding included bile duct infection with or wrthout residual cholelithia-sis in 56 cases , ascariasis of the biliary tract in 7 cases ,incorrect precedent surgi-cal procedure or compressive erosion of the bile duct by draining tube in 8 casesand post-operative biliary carcinoma in 2 cases. Among the 73 cases ,there wereintrahepatic hemobilia in 51, extrahepatic hemobilia in 20 and bleeding of thecholedochoenterostomy site in 2. Certain clinical characteristics of hemobilia af-ter biliary surgery were discussed. B-US cholangiography via T tube and selec-tive hepatic arteriography were of diagnostic value. But reviewing the history,checking the course of the precedent operation and choledochoscopy were of ut-most importance in defining the bleeding source. Out of 40 cases re-operated on,32 were cured. Out of 33 cases treated conservatively 28 were cured. The au-thors emphasized that the treatment of hemobilia should be selective according tothe bleeding cause ,the amount of bleeding,,the general condition of the patientand the varied pattern of hemobilia cycle.