摘要
胆管支气管瘘是临床少见病,现回顾2018年3月南京医科大学第二附属医院收治的1例胆管支气管瘘患者的临床资料并复习相关文献,结果发现肝动脉介入栓塞及射频消融术后是肝癌患者合并胆管气管瘘的主要危险因素,其主要临床表现包括大量黄绿色痰液、不易控制的肺部感染,可伴发热、胸痛等。当肝癌患者经肝动脉介入栓塞或射频消融术后,出现咳大量黄绿色胆汁样痰,特别是咳痰量超过100 ml/d、抗感染效果不佳及无法以感染解释的大量黄绿色痰液,应考虑到胆管支气管瘘的可能;痰液或支气管镜下肺泡灌洗液、胸腔引流液胆红素测定阳性有助于该病的诊断,内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)是确诊该病的重要手段,经皮经肝胆道引流术(percutaneous transhepatic cholangial drainage,PTCD)及膈肌修补术是该病的重要治疗方法,而胆道支架置入或单纯胸腔闭式引流亦可作为一般状况欠佳患者的治疗选择。
Bronchobiliary fistula is a rare disease. The clinical data of a case with bronchobiliary fistula admitted to The Second Affiliated Hospital of Nanjing Medical University in March, 2018 was retrospectively analyzed and relevant literatures were reviewed. Hepatic artery interventional embolization and radio frequency ablation are the main risk factors of bronchobiliary fistula for patients with liver cancer. The main clinical symptoms include massive yellow-green sputum and unmanageable lung infection, accompanied by fever, chest pain and other symptoms. When patients who developed liver cancer and accepted hepatic artery interventional embolization or radio frequency ablation had massive yellow-green bile-like sputum, especially more than 100 ml/d, unmanageable infection and unexplained excessive yellow-green sputum, bronchobiliary fistula should be considered;positive test of bilirubin in sputum, alveolar lavage fluid acquired by bronchoscopy or hydrothorax contributes to the diagnosis of the disease. Endoscopic retrograde cholangiopancreatography(ERCP) is an important method to confirm the disease. Percutaneous transhepatic cholangial drainage(PTCD) and diaphragmatic repair are crucial therapeutic methods for this disease. Biliary stent placement or simple closed drainage of pleural cavity can also be optional treatment for patients with poor general condition.
作者
张扬
高天明
王文晶
冯旰珠
浦福兴
ZHANG Yang;GAO Tian-ming;WANG Wen-jing;FENG Gan-zhu;PU Fu-xing(Department of Respiratory and Critical Care Medicine,The Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China;Department of Digestive,The Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)
出处
《中国肝脏病杂志（电子版）》
CAS
2019年第4期85-89,共5页
Chinese Journal of Liver Diseases：Electronic Version
基金
国家自然科学基金面上项目（81670013）
关键词
胆管支气管瘘
肝癌
肝动脉介入栓塞
射频消融
逆行胰胆管造影
经皮经肝胆道引流术
Bronchobiliary fistula
Liver cancer
Hepatic artery interventional embolization
Radio frequency ablation
Endoscopic retrograde cholangiopancreatography
Percutaneous transhepatic cholangial drainage
