胆道手术中意外大出血的原因及防治

Prevention and treatment of hemorrhage during operation of biliary tract

目的 探讨胆道手术中意外大出血的原因与防治措施。方法对2006年1月至2016年12月间在上海健康医学院附属周浦医院接受胆道手术时发生术中大出血的28例患者的临床资料进行回顾性分析。结果28例术中出血原因包括医源性损伤14例（50％），结石合并胆道感染9例（32．1％），胆囊床出血3例（10．7％），其他原因2例（7．1％）。手术时机：急诊手术18例，择期手术10例。平均出血量1600（600-3000）ml。依据术中具体的出血位置、出血量、出血原凶等情况而采取相应的处理。26例治愈、2例死亡，死f原因均为失血性休克、多器官功能衰竭。结论 医源性损伤、胆道感染和胆管结石是胆道手术中大出血的主要原因。胆道术中遇到意外大出血时应查明其原因和出血部位，并选择相应的处理方法。

Objective To investigate the methods for prevention and treatment of unexpected hemorrhage during operation of biliary tract. Methods The clinical data of 28 patients with intraoptrative hemorrhage from Jan. 2006 to Dec. 2016 in our hospital were retrospectively analyzed. Results The cause of introoperative hemorrhage included： iatrogenic biliary injuries in 14 cases （50%）, cholelithasis complicated biliary infection in 9 cases （32.1%）, bleeding in gall bladder bed in 3 patients （10.7%）, and other causes in 2 cases （7.1%）. The intraoperative blood loss was 600 to 3000 ml. According to the specific location of bleeding, the amount of blood loss, the cause of bleeding and other conditions, the individual treatment was given. 26 were cured and 2 died of hemorrhagic shock and MODS. Conclusions The major causes of hemorrhage during operation of biliary tract comprise iatrogenic biliary injuries, biliary infection, and biliary lithiasis. The reasonable treatment of intraopera- tive hemorrhage should be based on the concrete bleeding etiologies.