【摘要】 目的　探讨合并肝硬化的胆道疾病术中大出血的防治方法。方法　对 1996-2000 年期间经治的5例合并肝硬化的胆道疾病的术中大出血的病例的临床特点、出血原因及处理方法进行总结、分析。结果　肝硬化的原因:血吸虫肝病3例,慢性乙型肝炎2例。拟行胆道手术的种类:单纯胆囊切除3例,胆囊切除加胆总管探查2例。手术时机:急诊手术1 例,择期手术4例。出血部位:胆囊管周围曲张静脉出血2例,胆总管周围曲张静脉出血 3 例。出血量:1 200~7 600 ml。止血方法:压迫止血3例(其中2例再次损伤出血),单纯缝扎止血 1 例,切开胆总管置探条支撑后缝扎止血 1例,无法止血死亡1例(20%)。结论　合并有肝硬化的胆道疾病有很高的手术风险,预防最为重要。曲张静脉损伤出血首选压迫止血,如无效,则采用深缝扎止血,不可以钳夹、结扎。更多还原

【Abstract】 Objective To investigate the methods for prevention and treatment of formidable hemorrhage during operation of biliary tract in cirrhotic patients. Methods The clinical data of 5 cirrhotic patients experiencing lethal bleeding during operation of the biliary tract from 1996 to 2000 in our hospital were retrospectively analyzed. Results The reason for liver cirrhosis was schistosomiasis in 3 patients and chronic hepatitis B in the other 2. Cholecystectomy was performed for 3 patients and cholecystectomy and choledochotomy for the other 2. The bleeding appeared at the varicose veins around the ductus cycticus in 2 patients and varicose veins around the choledochus in other 3. The intraoperative blood loss was 1200 to 7600 ml. Pressure was resorted to stanch in 3 patients but rebleeding appeared in 2 of the 3 patients because of injury again. For the other 2 patients, simple stitch was performed for 1 and stitch with the support of a probe after opening the common bile duct in the other. One patient died of failure in hemostasis. Conclusions It is very dangerous to perform biliary tract operation in cirrhotic patients. When the varicose veins are injured to bleed, it is better to press for hemostasis at first and then to stitch deeply but not to ligate the veins.更多还原