胆道大出血的介入诊疗临床价值

doi:10.3877/cma.j.issn.2095-5782.2021.01.005

中华介入放射学电子杂志 ›› 2021, Vol. 09 ›› Issue (01) : 31 -35. doi: 10.3877/cma.j.issn.2095-5782.2021.01.005

所属专题：文献；

血管介入

胆道大出血的介入诊疗临床价值

鲁东¹, 储森林¹, 朱义江¹, 成德雷¹, 柴杰¹, 吕维富¹^,^†(

)

^1. 230001　安徽合肥，中国科学技术大学附属第一医院（安徽省立医院）介入放射科

收稿日期:2020-09-30 出版日期:2021-02-25
通信作者: 吕维富
基金资助:
2019年安徽省重点研究与开发计划项目(201904a07020091)

Clinical value of interventional diagnosis and treatment of massive hemobilia

Dong Lu¹, Senlin Chu¹, Yijiang Zhu¹, Delei Cheng¹, Jie Chai¹, Weifu Lv¹^,^†()

^1. Department of Interventional Radiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China; Anhui Provincial Hospital, Anhui Hefei 230001, China

Received:2020-09-30 Published:2021-02-25
Corresponding author: Weifu Lv

全文 ( ) 下载PDF ( ) 导出引用

目的

探讨胆道大出血介入诊疗临床价值。

方法

收集11例胆道大出血患者的临床资料，分析其出血原因及检查和治疗手段，评估其疗效和安全性。

结果

11例患者中9例为医源性胆道出血，占比达81.82％（9/11）。有胆道手术史者4例，经皮经肝胆道引流（PTBD）术后出血5例，PTBD后肝动脉损伤3例。11例患者中9例在肝动脉数字减影血管造影（DSA）确诊胆道出血后立即行超选择栓塞治疗，止血成功率88.89％（8/9）。11例患者均未出现肝脓肿、肝功能衰竭等严重并发症。

结论

医源性损伤是胆道大出血的主要原因，通过肝动脉造影及栓塞治疗可快速诊断并治疗致命性胆道大出血。

关键词: 胆道大出血, 介入放射学, 栓塞, 诊疗

Objective

To investigate the clinical value of interventional therapy for massive hemobilia.

Methods

The clinical data of 11 patients with massive hemobilia were collected, the causes of the hemobilia were analyzed, examination and treatment methods were analyzed, and the efficacy and safety were evaluated.

Results

Nine of the 11 patients had iatrogenic hemobilia, accounting for 81.82% (9/11). There were 4 cases of biliary surgery, 5 cases of bleeding after PTBD, and 3 cases of hepatic artery injury after PTBD. Among the 11 patients, 9 patients underwent selective embolization immediately after the diagnosis of massive hemobilia by digital subtraction angiography (DSA), and the success rate of hemostasis was 88.89% (8/9). There were no serious complications such as liver abscess and liver failure.

Conclusions

Iatrogenic injury is the main cause of massive hemobilia. Hepatic arteriography and embolization can diagnose and treat the fatal massive hemobilia quickly.

Key words: Massive hemobilia, Interventional radiology, Embolization, Diagnosis and treatment

图1 15岁男性，上腹痛1年余，加重伴呕血1周

图2 70岁男性，胰头癌肝转移胆道粒子支架术后15 d

[1]	Tanaka T, Takakura K, Maruyama Y, et al. Hemobilia derived from cystic artery pseudoaneurysm[J]. Case Rep Gastroenterol, 2019, 13(1): 89-94.
[2]	Murugesan SD, Sathyanesan J, Lakshmanan A, et al. Massive hemobilia: a diagnostic and therapeutic challenge[J]. World J Surg, 2014, 38(7): 1755-1762.
[3]	Staszak JK, Buechner D, Helmick RA. Cholecystitis and hemobilia[J]. J Surg Case Rep, 2019, (12): rjz350.
[4]	Zhou HB. Hemobilia and other complications caused by percutaneous ultrasound-guided liver biopsy[J]. World J Gastroenterol, 2014, 20(13): 3712-3715.
[5]	Bacalbasa N, Brezean I, Anghel C, et al. Management ofa fulminant upper gastrointestinal bleeding exteriorized through hemobilia due to arteriobiliary fistula between the common bile duct and a right hepatic artery aneurysm - a case report[J]. In Vivo, 2017, 31(5): 983-989.
[6]	Alrajraji M, Nawawi A, Jamjoom R, et al. Delayed hemobilia due to hepatic artery pseudo-aneurysm: a pitfall of laparoscopic cholecystectomy[J]. BMC Surg, 2016, 16(1): 59.
[7]	Santos T, Serra M, Oliveira A, et al. Dieulafoy lesion of the gallbladder: a rare cause of hemobilia and acute pancreatitis - case report[J]. Int J Surg Case Rep, 2020, 66: 207-210.
[8]	Hamada T, Yasunaga H, Nakai Y, et al. Severe bleeding after percutaneous transhepatic drainage of the biliary system: effect of antithrombotic agents--analysis of 34 606 cases from a Japanese nationwide administrative database[J]. Radiology, 2015, 274(2): 605-613.
[9]	Zhang DS, Metwalli Z, Hussain KB. Arterial-portal fistula after percutaneous liver biopsy in hepatic allograft causing hemobilia and pancreatitis[J]. Clin Gastroenterol Hepatol, 2017, 15(1): e3-e4.
[10]	Lee SH, Hong SG, Lee KY, et al. Delayed severe hemobilia after endoscopic biliary plastic stent insertion[J]. Clin Endosc, 2016, 49(3): 303-307.
[11]	Choi SH, Gwon DI, Ko GY, et al. Hepatic arterial injuries in3 110 patients following percutaneous transhepatic biliary drainage[J]. Radiology, 2011, 261(3): 969-975.
[12]	Puntel G, Puppini G, Perandini S, et al. Diagnosis and management of iatrogenic hemobilia secondary to transjugular intrahepatic portosystemic shunt procedure[J]. Cureus, 2020, 12(4): e7629.
[13]	Zhu JY, Huang J, Fan W, et al. Massive hemobilia due to a ruptured mycotic hepatic artery aneurysm associated with streptococcal endocarditis: case report[J]. J Int Med Res, 2020,48(3): 300060519883554.
[14]	Ayoola R, Jamindar P, Williams R. Venobiliary fistula with haemobilia: a rare complication of percutaneous liver biopsy[J]. BMJ Case Rep, 2017, bcr2016218930.
[15]	Hong DP, Xuan DP, Quang HH. Post-blunt traumatic hemobilia from pseudoaneurysm successfully treated with embolization[J]. Cureus, 2020, 12(5): e7961.
[16]	Wang XJ, Buttar N, Storm AC. Management of hemodynamic collapse after liver transplantation from native bile duct stump hemorrhage with gelfoam[J]. ACG Case Rep J, 2019, 6(10): e00254.

[1]	王濛, 王華麟, 王鉴, 孙锟. 先天性心脏病宫内诊疗现状与展望[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 481-485.
[2]	钱警语, 郑明明. 《2024意大利妇产科学会非侵入性和侵入性产前诊断指南》解读[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 486-492.
[3]	李国煜, 丛赟, 祖丽胡马尔·麦麦提艾力, 何铁英. 急性胰腺炎并发门静脉系统血栓形成的危险因素及预测模型构建[J/OL]. 中华普通外科学文献(电子版), 2024, 18(04): 266-270.
[4]	常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[5]	中华医学会器官移植学分会. 中国肺移植气道并发症临床诊疗指南（2024版）[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 266-274.
[6]	张春玉, 陈海云, 肖忠萍, 罗琴, 潘运昌. 血清NT-proBNP 预测肺栓塞心脏功能障碍的临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 805-808.
[7]	公宇, 廖媛, 尚梅. 肝细胞癌TACE术后复发影响因素及预测模型建立[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 818-824.
[8]	李一帆, 朱帝文, 任伟新, 鲍应军, 顾俊鹏, 张海潇, 曹耿飞, 阿斯哈尔·哈斯木, 纪卫政. 血GP73水平在原发性肝癌TACE疗效评价中的作用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 825-830.
[9]	张龙, 孙善柯, 徐伟, 李文柱, 李俊达, 池涌泉, 何广胜, 成峰, 王学浩, 饶建华. 腹腔镜脾切除治疗血液系统疾病的临床疗效分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 870-875.
[10]	周学锋, 董哲毅, 冯哲, 蔡广研, 陈香美. 糖尿病肾脏疾病中西医结合诊疗指南计划书[J/OL]. 中华肾病研究电子杂志, 2024, 13(06): 301-305.
[11]	刘华亭, 张媛, 张登文, 王杰, 袁阳. 介入栓塞联合手术切除治疗头皮动静脉畸形的疗效观察[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(05): 273-278.
[12]	蔡晓雯, 李慧景, 丘婕, 杨翼帆, 吴素贤, 林玉彤, 何秋娜. 肝癌患者肝动脉化疗栓塞术后疼痛风险预测模型的构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 722-728.
[13]	于洁, 金小红, 顾艳楣, 王慧, 葛杨杨, 李燕. 癌症相关静脉血栓栓塞症患者疾病体验与需求的质性研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 739-744.
[14]	赖海洋, 吴可通, 刘洋, 李丹, 彭焘, 万源, 张波. 术前经动脉栓塞在椎体转移瘤切除术中的应用[J/OL]. 中华介入放射学电子杂志, 2024, 12(04): 327-332.
[15]	朱洪申, 王思权, 彭靓, 张晓斌, 郑美云, 陈锦华. Glubran-2栓塞治疗鼻咽癌相关难治性鼻出血的临床疗效[J/OL]. 中华介入放射学电子杂志, 2024, 12(04): 333-337.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Clinical value of interventional diagnosis and treatment of massive hemobilia

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Clinical value of interventional diagnosis and treatment of massive hemobilia