胆道术后严重大出血54例临床分析

Severe hemorrhage after biliary surgery:A clinical analysis of 54 cases

目的分析胆道术后严重出血的临床病程和治疗效果。方法回顾性分析2016—2018年海军军医大学附属东方肝胆外科医院胆道外科行手术治疗的胆道疾病病人中需要行介入治疗(内镜和血管造影治疗)或再次手术的严重大出血者54例临床资料。结果胆道术后严重出血的发生率为1.7%(54/3183)。胆道术后严重出血相关的总体死亡率为0.53%(17/3183)。54例病人中,有3例行内镜检查,仅1例行内镜治疗成功止血;34例接受介入血管造影检查的病人中,23例接受了介入性栓塞治疗(包括介入性钢圈栓塞、覆膜支架等血管介入治疗),18例止血成功,成功率为78.3%(18/23)。35例行再次剖腹止血手术,其中19例将手术作为一线治疗方案,16例为内镜或介入治疗失败后行补救性治疗。结论胆道术后严重出血原因较多,临床表现多样,早期发现和治疗至关重要。应综合考虑发病时间、伴发并发症情况和初次手术方案制定治疗决策。介入治疗临床安全性和止血成功率较高,但在介入治疗止血失败的情况下应紧急中转手术治疗。

Objective To analyze the clinical process and treatment effect of severe hemorrhage after biliary surgery.Methods The clinical data of 54 patients with biliary disease who had severe hemorrhage and were needed intervention(endoscopy and radiation intervention)or reoperation after biliary surgery in Department of Biliary Surgery,Eastern Hepatobiliary Surgery Hospital,Naval Military Medical University between 2016 and 2018 were analyzed retrospectively.Results The incidence of severe hemorrhage after biliary surgery was 1.7%(54/3183).The total mortality associated with severe hemorrhage after biliary surgery was 0.53%(17/3183).Among the 54 patients,endoscopy was successful in 1 from 3 patients and only one case was successfully treated by endoscopy.From 34 patients subjected to angiography,23 underwent interventional embolization with a success rate of 78.3%(18/23).Overall,relaparotomy was performed in 35 patients among whom 19 underwent surgery as first-line treatment,while 16 were relaparotomied as rescue treatment after failure of interventional endoscopy or radiology.Conclusion There are many causes and clinical manifestations of severe hemorrhage after biliary surgery.Early detection and treatment are very important.Management of severe hemorrhage after biliary surgery should be done according to the time of bleeding occurrence,the coincident complications and the initial operative procedure.Interventional embolization has a highe hemostatic success rate.However,in the case of failure after interventional therapy,emergency treatment should be transferred as soon as possible.