Bloechle C, Izbicki J R, Rashed M Y, el-Sefi T, Hosch S B, Knoefel W T, Rogiers X, Broelsch C E
Department of Surgery, University of Hamburg, Federal Republic of Germany.
Am J Gastroenterol. 1994 Sep;89(9):1537-40.
Hemobilia is defined as hemorrhage into the biliary tract. To define a rational approach toward this rare entity, we performed a retrospective study on the presentation, diagnosis, and management of hemobilia.
During the past 3 yr, eight patients suffering from severe hemobilia presented to our departments. Jaundice, right-sided upper abdominal pain, and hematemesis were the most frequent symptoms. Hemobilia originated from iatrogenic injury in three patients, malignant hepatic or biliary tumors in three, parasitic infestation (ascariasis) in one, and coagulopathy due to end-stage liver cirrhosis in one. Duodenoscopy revealed bleeding from the papilla in all patients. Diagnosis was confirmed by endoscopic retrograde cholangiopancreatography and angiography in seven patients.
In three patients, major liver resections were performed that definitively controlled the bleeding and the underlying tumor. Angiographic occlusion of an arterial lesion was successfully achieved in two patients. In two patients, operative ligation of the supplying artery was required. The patient suffering from end-stage liver disease was treated by substitution of coagulation factors but died due to progressive metabolic liver failure.
Angiographic occlusion is recommended as initial treatment to control hemobilia and to render the patient stable in preparation for elective and definitive surgery. Surgery becomes necessary when nonoperative attempts to stop the bleeding fail and is required for tumors and parasitic disease.
胆道出血定义为血液进入胆道系统。为了确定针对这种罕见病症的合理治疗方法，我们对胆道出血的临床表现、诊断及治疗进行了一项回顾性研究。
在过去3年中，8例严重胆道出血患者前来我院就诊。黄疸、右上腹疼痛及呕血是最常见的症状。3例患者的胆道出血源于医源性损伤，3例源于肝脏或胆管恶性肿瘤，1例源于寄生虫感染（蛔虫病），1例源于终末期肝硬化所致的凝血功能障碍。所有患者经十二指肠镜检查均发现乳头出血。7例患者经内镜逆行胰胆管造影及血管造影确诊。
3例患者接受了肝大部切除术，成功控制了出血并切除了潜在肿瘤。2例患者通过血管造影成功闭塞了动脉病变。2例患者需要手术结扎供血动脉。1例终末期肝病患者接受了凝血因子替代治疗，但因进行性代谢性肝衰竭死亡。
建议将血管造影闭塞术作为控制胆道出血并使患者病情稳定以便为择期确定性手术做准备的初始治疗方法。当非手术止血尝试失败且对于肿瘤及寄生虫病必须进行手术时，则需进行手术治疗。
