DSA和介入栓塞术在急性动脉性出血诊断与治疗中的应用

Application of DSA diagnosis and interventional embolization therapy in various acute arterial bleeding

目的探讨数字减影血管造影和介入栓塞术对急性动脉性出血的诊断与治疗价值。方法急性出血患者22例,包括肝脏损伤出血4例,产后大出血7例,人流术后出血2例,大咯血6例,消化道出血3例。对出血部位行选择性DSA,明确诊断及出血动脉后在超选择插管基础上行栓塞治疗,栓塞材料为明胶海绵颗粒和/或聚乙烯醇颗粒。结果所有病例DSA均显示出血阳性征象,表现为造影剂外溢。22例栓塞治疗后出血均立即停止,随访3～24个月,1例大咯血患者在治疗后第4个月出血复发,遂行二次栓塞止血。未见严重并发症发生。结论DSA对诊断急性出血有较高的价值;介入栓塞术微创、并发症少,能迅速、安全、有效地控制出血,宜作为急性出血治疗的首先方法。

Objective To evaluate the clinical effect of digital subtraction angiography （DSA） diagnosis and interventional embolization therapy in various acute arterial bleeding. Methods Twenty two patients with various acute bleeding, including hepatic bleeding （n= 4）, postpartum bleeding （n= 7）, induced abortion bleeding （n= 2）, large hemptysis （n= 6）, gastrointestinal bleeding （n= 3）, underwent selective DSA and transcatheter arterial embolization with gelfoam particles and/or polyvinyl alcohol （PVA） particles. Results The positive signs of bleeding were observed in 22 cases drring DSA. Bleeding stopped immediately in all patients after embolization. During the follow-up of 3-24 months , large hemptysis recurred in 1 patients 4 months after embolization, and was treated successfully with re-embolization. No serious complications occured in all patients. Conclusion DSA is valuable for the diagnosis of various acute arterial bleeding. Interventional embolization therapy is a quick, safe and effective method to control hemorrhage, and should be taken as the first choice.