胆道出血的诊治进展

Advances in diagnosis and therapy of hemobilia

胆道出血是一种罕见的上消化道出血,但随着侵入性肝胆道技术的开展,胆道出血的发生率随之上升。胆道出血的病因复杂,若严重肝胆道感染、外伤、肝胆手术、有创胆道介入术后出现腹痛、黄疸或上消化道出血等临床表现,需警惕胆道出血的可能。介入仍是胆道出血的首选诊断及治疗手段。内镜适用于少量胆道出血的治疗,其他治疗包括手术治疗、经皮注射血凝酶、经皮经肝胆道引流术等。本文对胆道出血的病因、发病机制、临床表现、诊断和治疗最新进展作一概述,以期进一步提高其诊治效果。

Hemobilia is a rare source of upper gastrointestinal bleeding,but the incidence is increasing along with the rise in minimally invasive biliary interventions.The etiology of hemobilia is complex.If clinical manifestations such as severe hepatobiliary infection,trauma,hepatobiliary surgery,abdominal pain,jaundice or upper gastrointestinal bleeding occurred after invasive biliary intervention,it is necessary to guard against the possibility of hemobilia.Interventional radiology may be the first-line diagnostic and therapeutic option for patients with a high suspicion of hemobilia.Endoscopy should be reserved for cases of modicum hemobilia,other options include surgery,thrombin injection,and/or placement of a percutaneous biliary drain.This paper reviewed the etiology,pathogenesis,clinical manifestations,diagnosis and treatment of hemobilia in order to improve its clinical effect further.