服用抗凝药患者胆道出血的特殊性和处理策略

Particularity and Treatment Strategy of Patients with Hemobilia Taking Anticoagulants

目的:探讨胆道出血患者的临床表现、治疗及服用抗凝药患者围手术期处理的特殊性。方法:回顾性分析1998年1月-2012年12月笔者所在医院收治的23例胆道出血患者临床表现、诊断和治疗过程。结果:本组胆道出血患者大多伴有上消化道出血的症状,6例以胆管炎为首发症状。一般可以通过B超和CT发现原发病灶,通过十二指肠镜和腹腔动脉造影确诊。其中12例经过手术治疗,4例行选择性动脉栓塞术治疗,7例进行保守治疗。对于服用华法林的患者可用维生素K1抗凝,阿司匹林的患者根据情况处理,围手术期可用低分子肝素过渡。治愈19例,占82.6%,死亡4例,占17.4%。结论:准确的诊断、积极有效的围手术期处理与正确的术中处理或有效的保守治疗措施是胆道出血治疗的重要保障。

Objective：To explore the clinical manifestations,treatment and particularity of patients with hemobilia taking anticoagulant in perioperative period.Method：The clinical manifestations,diagnosis and treatment process of 23 cases with hemobilia in our hospital from January 1998 to December 2012 were analyzed retrospectively.Result：Most of patients with biliary tract hemorrhage of upper gastrointestinal bleeding symptoms,there were 6 cases with cholangitis as the first symptom.Can generally be found by B-ultrasound and CT primary lesion,and the celiac artery through duodenoscopy angiography.12 cases were given surgery,4 cases selective arterial embolization,conservative treatment in 7 cases.For patients taking warfarin anticoagulation vitamin K1 was available,depending on the circumstances of aspirin treatment in patients with perioperative available low molecular weight heparin（LMWH） transition.19 cases cured,accounting for 82.6%,4 cases were deaths,accounting for 17.4%.Conclusion：The good results of hemilia patient could be achieved by accurate diagnosis,exact operation and active perioperative management or effective conservative therapy.