摘要
We report a case of postoperative refractory bile leakage managed successfully by intrahepatic biliary ablation with ethanol. A 75-year-old man diagnosed with hepatocellular carcinoma underwent extended posterior segmentectomy including the caudate lobe and a part of the anterior segment. The hepatic tumor attached to the anterior branch of the bile duct was detached carefully and resected. Fluid drained from the liver surface postoperatively contained high concentrations of total bilirubin, at a constant volume of 150 mL per day. On d 32 after surgery, a fistulogram of the drainage tube demonstrated an enhancement of the anterior bile duct. Endoscopic retrograde cholangiography demonstrated complete obstruction of the proximal anterior bile duct and no enhancement of the peripheral anterior bile duct. On d 46 after surgery, a retrograde transhepatic biliary drainage （RTBD） tube was inserted into the anterior bile duct under open surgery. However, a contrast study of RTBD taken 7 mo post-surgery revealed that the fistula remained patent despite prolonged conservative man- agement, so we decided to perform ethanol ablation of the isolated bile duct. Four mL pure ethanol was injected into the isolated anterior bile duct for ten minutes, the procedure being repeated five times a week. Following 23 attempts, the volume of bile juice reached less than 10 mL per day. The RTBD was clamped and removed two days later. After RTBD removal, the patient had no complaints or symptoms. Follow-up magnetic resonance imaging demonstrated atrophy of the ethanol-injected anterior segment without liver abscess formation.
我们报导手术后的倔强的胆汁漏的一个案例与乙醇由肝内的胆汁的脱离成功地设法。与肝细胞癌诊断的一个 75 岁的人包括有尾的脑叶和前面的片断的部分经历了扩大以后的 segmentectomy。纳入胆汁管的前面的分支的肝的肿瘤小心地被分开并且 resected。手术后地从肝表面排干的液体包含了全部的胆红素的高集中，在每天的 150 mL 的经常的体积。在 d 上 32 在外科以后，引流管的 fistulogram 表明了前面的胆汁管的改进。内视镜后退胆管造影术表明了近似前面的胆汁管和外部前面的胆汁管的没有改进的完全的阻塞。在 d 上 46 在外科以后，一后退 transhepatic 胆汁的排水(RTBD ) 试管在开的外科下面被插入到前面的胆汁管。然而，拿的 RTBD 的对比研究 7 瞬间外科以后表明尽管有延长保守管理，管仍然是专利，我们因此决定执行孤立的胆汁管的乙醇脱离。四 mL 纯乙醇被注入孤立的前面的胆汁管十分钟，过程一个星期正在被重复五次。追随者 23 尝试，胆汁果汁的体积每天到达了不到 10 mL。RTBD 二天以后被夹钳并且搬迁。在 RTBD 移动以后，病人没有抱怨或症状。没有肝脓肿形成，后续磁性的回声成像表明了注射乙醇的前面的片断的萎缩。
