创伤性血胆症

目的 探讨创伤性血胆症的发病机制、临床特点及防治方法。方法 对1978-2002年国内文献报告的15例和我院收治的1例创伤性血胆症病人的临床资料进行总结分析。结果 肝破裂修补术后11例,填塞止血术后4例,PTCD 1例。伤后发生胆道出血时间:<1周6例,1-3周6例,>3周4例。右上腹疼痛15例,便血16例,呕血10例,T管流血3例,PTCD管流血1例,黄疸9例。行再次手术治疗13例,非手术治疗3例。治愈12例,死亡4例。结论 创伤性血胆症是肝外伤的严重并发症,典型表现为胆绞痛、黄疸和上消化道出血三联症。具有上消化道出血与受伤时间的脱离现象,出血多可自行缓解,但常反复发作。对肝外伤创面进行彻底清创止血是防治本症的关键。本症以手术治疗为主。

Traumatic hemobilia

jective To explore the pathogenesis, clinical features, prevention and treatment of traumatic hemobilia. Methods The clinical data of 16 patients with traumatic hemobilia (15 reported by literature and 1 treated in our hospital) from 1978 to 2002 were retrospectively analyzed. Results In this group, 15 cases were caused by rupture of the liver and 1 by PTCD. Hemobilia occurred less than 1 week after liver trauma in 6 cases, 1-3 weeks in 6 and over 3 weeks in 4. Physical examination revealed pain in the right upper abdomen in 15 cases, hematochezia in 16, hematemesis in 10, T-tube bleeding in 3, PTCD-tube bleeding in 1 and jaundice in 9. Thirteen patients underwent reopera-tion while the other 3 were non-operatively treated. In this series of patients, 4 died Conclusions Traumatic hemobilia is a severe complication secondary to liver trauma. It usually appears with the typical Sandblom's triad of biliary colic, jaundice and hematemesis and/or melena. The upper digestive bleeding is not related to the time of injury. The bleeding can relieved by itself but may repeatedly relapse. Complete debridement and careful hemostasis in the injured area of the liver play a key role in prevention of traumatic hemobilia. Operation is the major means for its management.