胆道出血的诊断与处理(附37例报告)

Diagnosis and management of 37 cases of hemobilia

目的探讨胆道出血的原因及处理方法。方法回顾性分析武汉大学人民医院2007年3月至2018年3月收治的37例胆道出血病人的出血原因及其治疗方法,总结出胆道出血的诊治流程。结果黑便、CT/B超提示可初步诊断胆道出血,术中胆道出血直接肉眼可见,出血量>100 ml,术后腹腔引流管引流出血性液体>150 ml,血红蛋白进行性下降诊断为胆道出血。37例病人中,术前胆道出血14例,术中胆道出血16例,术后胆道出血7例。16例保守治疗,15例痊愈,1例因胆管癌全身扩撒,全身出血伴失血性休克而死亡;17例手术治疗止血成功;4例行肝动脉造影栓塞治愈。结论胆道出血病人主要原因为肝胆管结石和胆道感染。应迅速分析胆道出血原因,结合出血量来选择治疗方法。肝动脉介入栓塞治疗是治疗胆道出血有效且安全的方法,及时手术也是提高胆道出血生存率的关键。

Objective To investigate the cause and treatment of hemobilia.Methods The cause and treatment of hemobilia in 37 cases from March 2007 to March 2018 were retropecively analyzed,and the approach of diagnosis and treatment was summarized.Results Melena and seroperitoneum showed in CT/B ultrasonic examination could initially diagnose hemobilia.Hemobilia could be seen directly during opeation with great blood loss.Hemobilia could be diagnosed by greater abdominal drainage amount more than 150 mL with hemoglobin progressive decline postoperatively.Of all 37 cases,preoperative hemobilia occurred in 14 cases,16 cases intraoperatively,and 7 cases postoperatively.Sixteen cases were given conservative treatment(15 cases cured,and 1 case died of hemorrhage shock),17 cases received the surgical operation,and 4 cases underwent hepatic artery embolization angiography.Conclusion The main cause for hemobilia is hepatolithiasis and biliary infection.The cause should be rapidly analyzed to choose the treatment concerning the amount of bleeding.Hepatic artery embolization angiography is effective and safe method for the management of hemobilia,while prompt operation is the key to improve the survival rate of hemobilia.