[Precise orientation and hepatectomy in the management of bili...

OBJECTIVE: To determine the method for locating the hemorrhagic site of biliary tract and assess the value of hepatectomy. METHODS: Clinical data of 23 patients with biliary tract hemorrhage undergoing liver segmentectomy between January 1998 and October 2008 were analyzed. There were infection of biliar tract or hepatolithiasis in 14 patients (60.9%), trauma in 6 (26.1%) and primary liver cancer in 3 (10.0%). Precise orientation was achieved by selective angiography in 5 patients and by bile duct exploration in 18. Operative approaches included left hemi-hepatectomy in 6 patients, left lateral lobectomy in 8, right hemi-hepatectomy in 4 and combined right segmentectomy in 5. RESULTS: All cases were successfully treated without any operative mortality. A majority of complications were bile leakage in 2 cases, subphrenic infection in 1, stress gastric ulcer in 1 and acute renal failure in 1. During the follow-up period of 8 months-10 years in 15 patients, 3 died of recurrent or metastasis liver cancer and 2 biliary cirrhosis. CONCLUSION: Hepatectomy is advocated for the management of biliary tract hemorrhage if bleeding is localized to a definite segment and the patient can tolerate the procedure.