Izbicki J R, Bloechle C, Kühn R, Knoefel W T, Rogiers X, Broelsch C E
Abteilung für Allgemeinchirurgie, Universität Hamburg.
Zentralbl Chir. 1995;120(6):455-60.
Hemobilia, defined as hemorrhage arising from pathological changes in the biliary tract, represents a rare entity. In a retrospective study the presentation, diagnosis, and management of hemobilia were investigated.
Since January 1991 six patients suffering from severe hemobilia presented to our department. Jaundice, right upper quadrant abdominal pain, hematemesis and melaena were the most frequent symptoms leading to admission. Hemobilia originated from iatrogenic injury following percutaneous liver biopsy and endoscopic removal of common bile duct stones, and malignant hepatic or biliary tumors. Duodenoscopy revealed bleeding from the papilla in all patients. Diagnosis was confirmed by ERCP in all patients and angiography in 5 of 6 patients.
Angiographic occlusion of an arterial lesion with coils was successfully achieved in one patient. One patient was treated conservatively. In 3 patients liver resections were performed to control bleeding and the underlying tumorous pathology. In another patient, operative ligation of the supplying artery had to be performed. Within a minimum follow-up of six months none of the six patients showed recurrence of hemobilia.
Considering the impact of etiologic, diagnostic and therapeutic aspects in treatment of hemobilia we suggest an algorithm for a rational approach to hemobilia. Angiographic occlusion may control the bleeding and improve the patient's general condition. Definitive surgical treatment of hemobilia is safe and effective.
胆道出血是指由胆道病理改变引起的出血，是一种罕见的病症。本回顾性研究对胆道出血的临床表现、诊断及治疗进行了调查。
自1991年1月起，有6例严重胆道出血患者前来我科就诊。黄疸、右上腹腹痛、呕血及黑便是导致患者入院的最常见症状。胆道出血源于经皮肝穿刺活检、内镜下胆总管结石取出术后的医源性损伤，以及肝脏或胆管恶性肿瘤。所有患者经十二指肠镜检查均发现乳头出血。所有患者均经内镜逆行胰胆管造影（ERCP）确诊，6例患者中的5例经血管造影确诊。
1例患者通过血管造影用弹簧圈成功封堵了动脉病变。1例患者接受了保守治疗。3例患者接受了肝切除术以控制出血并处理潜在的肿瘤病变。另1例患者不得不进行供应动脉的手术结扎。在至少6个月的随访期内，6例患者均未出现胆道出血复发。
考虑到病因、诊断及治疗方面对胆道出血治疗的影响，我们提出了一种合理治疗胆道出血的方案。血管造影封堵可控制出血并改善患者的一般状况。胆道出血的确定性手术治疗安全有效。
