PTB术后胆道出血的临床特征及诊治分析.docVIP

PTBD术后胆道出血的临床特征及诊治分析 1、 陕丙省丙安市陕丙省人民医院 陕丙丙安710068 2、 陕丙省丙安市丙安交通大学第一附属医院 陕丙丙安7100 68 范志勇（1982-）,男，陕丙省万荣人，在读博士，主治医师，研究方 向：肝胆胰脾疾病。 】目的探讨经皮肝穿刺胆汁引流（PTBD）术后胆道出血的临床特 征及治疗方法。方法回顾23例PTBD术后胆道出血患者的病例资料，对首次岀 血时间、出血原因、治疗方法及效果进行总结分析。结果3例患者首次出血时 间1-2天，胆道造影提示肿瘤组织出血，经保守治愈。15例疑似血管损伤患者首 次出血时间6.9plUSmn;2.7天，均行胆道造影、针道造影或血管造影检查。其中， 肝动脉分支出血10例，均行动脉栓塞一期治愈9例，1例术后再出血并肝左叶 脓肿形成。2例门静脉出血及3例出血部位不明患者经调整引流管，保守治愈。 余5例患者胆道出血考虑与瘤组织出血及凝血障碍有关，首次山血时间40天-11 月，3例经胆道支架置入、PTBD或ERCP治愈，2例经保守治疗后好转。结论PTBD 术后胆道出血首次出血时间与出血原因相关，选择合理的介入造影不仅可明确出 血部位，亦可施行有效治疗。 关键词】经皮肝穿刺胆汁引流，胆道出血，介入放射学 】R2S2.77 】A 】1001-5213（2016）09-0287-02 [Abstract] Objective To investigate the clinical characteristics and treatment of hemobilia after PTBD. Methods A total of 23 patients diagnosed as hemobilia were reviewed retrospectively and the initial bleeding time, source of bleeding, treatment and effects were analyzed. Results The initial bleeding time in 3 patients prompted tumor tissue bleeding by cholangiography were 1 to 2 days，and these patients were cured after conservative treatment. The initial bleeding time in 15 patients with suspected vascular injury is 6.9 plusmn; 2.7 days, and then these patients underwent cholangiography, needle angiography or angiography. After interventional angiography, the branch of hepatic artery injuries are identified in 10 patients and then embolized using coils, 9 of them were cured, rebleeding of biliary and abscess formation in liver left lobe occurred in 1 case. 2 patients with portal vein hemorrhage and 3 patients with obscure bleeding site were cured by adjusting the drainage tube. 5 patients with hemobilia associated with tumor bleeding and coagulation were cured by placement of stent, ERCP, PTBD or conservative treatment. Conclusion There is correlation between the initial bleeding time and the source of hemorrhage. Choose a reasonable intervention angiography can not only clear bleeding site, also take effective treatment. 经皮肝穿刺胆汁引流（PTBD）因其微创性及奋效性越来越多的砬 用于胆道恶性梗阻的姑总性治疗、胆道重症感染、胆道疾病的诊断等方面，其潜