肝损伤手术后胆道出血的诊断

The point of diagnosis and therapy in biliary tract massive hemorrhage after post-hepatorrhaphy

目的探讨肝损伤修补术后再次胆道大出血（简称肝术后胆道出血）诊断要点及体会。方法对1982年以来我院收治的11例肝术后胆道出血患者进行分析。结果11例全部为肝损伤修补手术后再次胆道出血患者，出血发作次数为4—10次，其中不能行血管造影的4例及1例合并肝脓肿与腹壁窦道者行手术治疗，3例经皮肝穿及保守治疗，3例行紧急行腹腔动脉及选择性右肝动脉造影，明确出血部位后进行栓塞治疗。结论严重肝损伤患者初次手术如果止血不充分、修补不完全或并发感染者，术后可出现胆道反复出血，选择性右肝动脉造影及栓塞在诊断和治疗中具有重要意义，在无其他并发症的前提下，应作为首选治疗方法。

Objective To enrich experiernces from our investigating into the point of diagnosis and therapy at biliary tract massive hemerrhage.Methods Eleven patients with retrospectively analysis, who and been received in hospital since 1982 with a diagnosis of 4 to 10 time＇ s biliary tract massive hemorrhage after post - hepatorrhaphy. Results We found that 4 in early stage and another combining conourrently with liver abscess or abdominal sinuses were not fitted to be treated with surgical operation. The other three were treated with embolism therapy after urgent belly cavity artery and alternative right - liver artery angiography. Conclusion Suppose patients with severe hepatic injury with symptom of no - mopping bleeding or mended incompletely, alternative right - liver artery angiography and embolism therapy is importance and the best selection.