肝损伤修补术后胆道大出血6例临床分析

Clinical Analysis of 6 Cases with Tract Massive Hemorrhage after Post-hepatorrhaphy

目的探讨肝损伤修补术后胆道大出血（简称肝术后胆道出血）发生原因及临床过程,结合文献总结诊断与治疗经验.方法对1982年以来我院收治的6例肝术后胆道出血患者进行回顾性分析.结果6例全部为行肝损伤修补术后胆道大出血患者,出血发作次数为4-10次,其中早期2例及1例合并肝脓肿与腹壁窦道者行手术治疗,其余3例均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或修补不完全,术后可出现胆道大出血,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,应作为首选治疗方法.

Objective To investigate the etiology and clinical process of biliary tract massive hemorrhage after post-hepatorrhaphy, and summarize the experiences of the diagnosis and therapy through reviewing the references. Methods Retrospectively analyze six patients with biliary tract massive hemorrhage after post- hepatorrhaphy administered to our hospital since 1982. Results 6 patients with biliary tract massive hemorrhage after post-hepatorrhaphy, and their hemorrhage occurred 4- 10 times. Among them two patients in early stage and one patient complicated with liver abscess and abdominal sinuses were treated with surgical operation. The other three patients were treated with embolism therapy after localizing hemorrhage through urgent bell cavity artery and alternative right-liver artery angiography.Conelusion If patients with severe hepatic injury weren＇t completely controlled bleeding or mended incompletely, biliary tract massive hemorrhage may occur after surgery. Alternative right-liver artery angiography and embolism are important in diagnosis and treatment, and is the best selection.