肝门部胆管癌根治性切除术后出血的诊疗策略

The strategy of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma

目的探讨肝门部胆管癌根治性切除术后出血的治疗及预防策略。方法复习近年来国内外的相关文献,对肝门部胆管癌根治性切除术后出血的治疗及预防进展进行综述。结果明确肝门部胆管癌根治性切除术后出血的时间、程度、原因以及部位有助于临床医生选择合适的干预时机和治疗方式。术后早期出血且程度较轻的患者可行保守治疗,若出血严重、血流动力学紊乱则须果断手术干预;晚期出血的后果严重,应尽早行血管介入治疗或手术治疗。结论对于肝门部胆管癌根治性切除术患者,需要做到术前精确评估、术中精细操作及术后加强精良管理,以减少肝门部胆管癌根治性切除术后出血的发生。若出现术后出血,需明确出血的原因、部位、时间及其程度,以利于临床医生快速作出临床决断并制定治疗方案。

Objective To investigate the strategy of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma. Method Reviewing the related literatures at home and abroad in recent years, to summarize the progress of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma. Results We should clear the postoperative bleeding time, extent, cause, and location, to help the clinician to choose the appropriate timing of intervention and treatment. The patients with early hemorrhage and mild degree hemorrhage could be treated conservatively. If patients with severe hemorrhage and hemodynamic disorders, surgical intervention must be decisive. Patients with late hemorrhage would have serious consequences, and these patients should receive interventional or surgical treatment as early as possible. Conclusions For patients with hilar cholangiocarcinoma after radical resection, doctors need to do accurate preoperative evaluation, meticulous operation, and intensive management after operation, to reduce the incidence of hemorrhage after radical resection of hilar cholangiocarcinoma. If the postoperative hemorrhage occurs, the cause, location, time, and degree of hemorrhage should be clearly defined to facilitate clinicians to make rapid clinical decisions and to develop treatment programs.