应用x线血管内方法诊断和治疗因腹腔穿透伤引起的创伤后胆道出血。我们自己的经历

K. S. Belyuk, E. Mogilevets, A. Zabolotnaya, D. Y. Yakovchik, R. S. Shilo, L. F. Vasilchuk, O. S. Soroka
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引用次数: 0

摘要

背景胆汁是指血液和胆汁一起通过肝内和肝外胆管排出。尽管使用了新的诊断和治疗方法,胆道出血的死亡率仍然很高(20-40%)。客观的介绍一例胆道出血的临床病例及诊断和治疗方法。材料和方法。本文介绍了一例腹腔穿透性刀伤合并胆道出血的患者的临床观察。根据Pikovsky的说法,进行了两个阶段的治疗,包括上中线剖腹手术、胆囊切除术和胆道卫生,并对总胆管进行外引流,同时对受损的第4肝段动脉进行血管栓塞。后果临床病例分析表明,X射线血管内治疗方法是提高外伤性胆道出血手术治疗效率的有效途径之一。结论。这一观察结果表明,在肝损伤的穿透性腹部伤口中,有可能出现胆道出血,而没有腹腔内出血的迹象。X射线血管内诊断方法的使用可以改善外伤性胆道出血患者的治疗结果。
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THE USE OF X-RAY ENDOVASCULAR METHODS OF DIAGNOSIS AND TREATMENT IN A PATIENT WITH POSTTRAUMATIC HEMOBILIA DUE TO PENETRATING WOUND OF THE ABDOMINAL CAVITY. OUR OWN EXPERIENCE
Background. Hemobilia is the excretion of blood alongside with bile through intra- and extrahepatic bile ducts. Despite the use of new methods of diagnosis and treatment, the mortality rate from hemobilia remains high (20-40%). Objective. To demonstrate a clinical case and some methods of diagnosis and treatment of a patient with hemobilia. Material and methods. The article presents our own clinical observation of a patient with a penetrating knife wound of the abdominal cavity with liver injury complicated by hemobilia. Two-stage treatment was performed including upper midline laparotomy, cholecystectomy, and biliary tract sanitation with external drainage of the common bile duct according to Pikovsky in combination with angioembolization of the damaged artery of the 4th liver segment. Results. The analysis of the clinical case shows X-ray endovascular methods to be one of the promising ways of increasing surgical management efficiency of traumatic hemobilia. Conclusions. This observation shows the possibility of developing hemobilia without signs of intra-abdominal bleeding in penetrating abdominal wounds with liver injury. The use of X-ray endovascular diagnostic methods can improve treatment outcomes of patients with hemobilia of traumatic origin.
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