CAJ | 학술논문

目的探讨创伤性胆汁瘤的成因、诊断和治疗方法.方法回顾性分析10年间肝和胆道损伤患者资料和胆汁瘤的诊治情况.结果 46例胆汁瘤中,40例发生在Ⅲ～Ⅴ级肝损伤后,胆汁瘤发生率为15.2％(40/263).Ⅳ、Ⅴ级与Ⅲ级肝损伤胆汁瘤发生率分别为22.6％ (31/137)和7.1％ (9/126)(x2=12.20,P＜0.01);钝性和穿透性肝损伤胆汁瘤发生率分别为19.3％(35/181)和6.1％ (5/82)(x2=7.67,P＜0.01).46例胆汁瘤中36例发生在非手治疗后,4例出现在手术治疗后.另6例为肝外胆道损伤所致,发生率18.8％(6/32).46例均经螺旋CT检查,9例同时行MRI;11例加做ERCP.肝损伤后胆汁瘤40例中,28例经超声或CT引导下穿刺置管引流治愈;12例＜30 cm3的胆汁瘤自行吸收.肝外胆道损伤所致6例经手术治愈.本组无死亡,亦无与胆汁瘤治疗相关的并发症.结论非手术治疗严重肝损伤应警惕胆汁瘤发生;肝损伤后胆汁瘤优先选择超声或CT引导下穿刺置管引流,肝外胆道损伤引起者多需手术治疗.
목적 탐토창상성담즙류적성인、진단화치료방법.방법 회고성분석10년간간화담도손상환자자료화담즙류적진치정황.결과 46례담즙류중,40례발생재Ⅲ～Ⅴ급간손상후,담즙류발생솔위15.2％(40/263).Ⅳ、Ⅴ급여Ⅲ급간손상담즙류발생솔분별위22.6％ (31/137)화7.1％ (9/126)(x2=12.20,P＜0.01);둔성화천투성간손상담즙류발생솔분별위19.3％(35/181)화6.1％ (5/82)(x2=7.67,P＜0.01).46례담즙류중36례발생재비수치료후,4례출현재수술치료후.령6례위간외담도손상소치,발생솔18.8％(6/32).46례균경라선CT검사,9례동시행MRI;11례가주ERCP.간손상후담즙류40례중,28례경초성혹CT인도하천자치관인류치유;12례＜30 cm3적담즙류자행흡수.간외담도손상소치6례경수술치유.본조무사망,역무여담즙류치료상관적병발증.결론 비수술치료엄중간손상응경척담즙류발생;간손상후담즙류우선선택초성혹CT인도하천자치관인류,간외담도손상인기자다수수술치료.
Objective To probe the causes,early recognition and effective therapy of posttraumatic biloma.Methods The data of all patients with the injury of the liver and bile duct treated in our center during the past 10 years were reviewed.Patients,diagnosed with biloma were retrospectively analyzed in respects of sex,age,cause of biloma,methods and efficacy of diagnosis and treatment.Results There were 46 patients with biloma.Of them,40 were found after liver trauma of grade Ⅲ-Ⅴ.The incidence of biloma was 15.2％ (40/263).In grade Ⅳ,Ⅴ,and Ⅲ,it was 22.6％ (31/137) and 7.1％ (9/126) respectively (x2 =12.20,P ＜ 0.01) and in blunt and penetrating injury,it was 19.3％ (35/181) and 6.1％ (5/82) respectively (x2 =7.67,P ＜ 0.01).Of these 40,36 were found during the course of conservative therapy of severe liver trauma; and 4 were found after laparotomy for the liver trauma.The remaining 6 cases of biloma had a history of injury to extrahepatic bile duct with a incidence of 18.8％(6/32).All 46 patients received spiral CT scaning plus MRI in 9,and ERCP in 11.Of those 40 with biloma after severe liver trauma,28 were cured by ultrasound-guided or computed tomography scan-guided pigtail drainage; and the remaining 12,in whom the biloma volume ＜ 30 cm3 resolved spontaneously.Six patients in whom the biloma as a result of injury to extrahepatic bile duct were cured by surgical intervention.There was no death and complication related with the therapy of biloma.Conclusions Attention should be given to biloma formation,when nonoperative therapy is exercised for severe liver trauma.Ultrasound-or CT scan-guided pigtail drainage is an effective option,but those due to injury of extrahepatic bile duct require surgical intervention.