胆道镜钬激光热凝术治疗肝内胆管出血

Holmium laser coagulation under choledochoscope for the treatment of intrahepatic hemobilia

    摘要
  • 摘要:
    目的   探讨胆道镜钬激光热凝术治疗肝内胆管出血的疗效。
    方法  回顾性分析2003年6月至2011年8月成都军区总医院采用胆道镜钬激光热凝术治疗55例肝内胆管出血患者的临床资料。术中胆道镜检查证实患者胆道出血后，从胆道镜器械孔插入钬激光光导纤维，使其顶端接近出血区域，直视下激发激光止血。如出血量多，影响出血区域的观察，加用肝门阻断带临时阻断肝门，同时配合使用胆道镜加压注液袋；对于胆管狭窄且远端出血者，先用激光切开狭窄或术中采用胆道气囊扩开狭窄区，恢复胆道通畅后完成止血。
    结果  55例患者均通过胆道镜钬激光热凝术成功止血，平均止血时间为5.5 min(2～15 min)；16例患者临时阻断肝门，共27次，平均阻断时间为2.2 min(1～4 min)；术后胆道再出血2例，均经非手术治疗治愈。患者均未发生操作相关并发症，痊愈出院。术后35~49 d患者复查胆道镜，41例术中热凝止血区域的胆管黏膜上皮恢复平坦，14例未出现原热凝区新的狭窄。
    结论  在胆道镜直视下应用钬激光凝固治疗肝内胆管出血是一种简单有效的方法。

     

    Abstract:
    Objective  To investigate the efficacy of holmium laser coagulation under choledochoscope for the treatment of intrahepatic hemobilia.
    Methods  The clinical data of 55 patients with intrahepatic hemobilia who received holmium laser coagulation under choledochoscope at the General Hospital of Chengdu Military Area from June 2003 to August 2011 were retrospectively analyzed. After the hemobilia was confirmed with choledochoscopy, an optical fiber of holmium laser was inserted into the intrahepatic bile duct from the hole of choledochoscope. The top of the optical fiber was posed close to the bleeding region, and then the laser was stimulated for coagulation under direct vision. If the observation of the bleeding area was influenced by the bleeding, the porta hepatis was temporarily occluded with a rubber hose combined with pressurized liquid injection bag. For patients with distal bile duct stenosis and bleeding, the narrow area was first expanded by biliary balloon or laser, then hemostasis was completed after the flow of bile duct was restored.
    Results  The hemorrhage of the 55 patients was controlled, with an average time of 5.5 minutes (range, 2-15 minutes). Temporary hepatic portal clamping was applied for 16 patients (27 times), and the average blocking time was 2.2 minutes (range, 1-4 minutes). Biliary rehaemorrahagia occurred after operation in 2 patients, and they were cured by nonsurgical treatment. All patients were discharged after successful hemostasis. The time of follow-up was 35-49 days. The epithelium of the bile duct coagulated by intraoperative holmium laser restored flat in 41 patients, and new biliary stricture was not found in the other 14 patients.
    Conclusion  Holmium laser coagulation under choledochoscope for intrahepatic hemobilia is simple and effective.

     

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