胆道出血的外科治疗与手术时机

Hemobilia with Surgical Timing of Surgical Treatment

目的探讨胆道出血的诊断、外科治疗与手术时机。方法对2008年3月—2011年3月收治的23例胆道出血患者的临床资料进行回顾性分析,并对相关危险因素进行多元回顾分析。结果重症急症胆管炎病变占47.82%、胆道蛔虫占21.74%、急性胆囊炎占13.04%、细菌性肝脓肿占4.35%、外伤性肝破裂占4.35%、高位胆管切开取石T管引流术后出血占4.35%、胆管-空肠Roux-en-Y式吻合术后出血占4.35%;回顾分析显示重症急症胆管炎是发病的主要原因。结论胆道出血应以急诊手术为主。出血期进行探查,病因病灶易于定位,止血效果术中即能确定,从而能增加手术止血的准确性及彻底性。

Objective Explore the diagnosis and surgical hemobilia treatment and opportunity.Methods From March 2008 to March 2011,we retrospectively analyse 23 cases hemobilia patients for clinical data and associated risk factors.Results Severe acute cholangitis lesions takes 47.82%,Biliary tapeworm takes 21.74%,Acute cholecystitis takes 13.04%,Bacterial liver abscess takes 4.35%,Traumatic liver rupture takes 4.35%,High bile duct cut stone-free t-tube drainage postoperative bleeding was 4.35%,Bile duct - jejunum Roux-en-Y type anastomosis postoperative bleeding was 4.35%.Review analysis showed that Severe acute cholangitis is the main reason of disease sends.Conclusion Hemobilia should take emergency surgery as the principal treatment.Do exploration during bleeding period,so causes are easy to find,and we can determine the hemostasia in order to increase veracity and thoroughness of operation.