胃十二指肠动脉假性动脉瘤血管造影诊断及栓塞治疗

Angiographic Diagnosis and Transcatheter Arterial Embolization in the Treatment of Gastroduodenal Artery Pseudoaneurysms

目的探讨血管造影诊断及栓塞治疗胃十二指肠动脉假性动脉瘤的方法。资料与方法12例胃十二指肠动脉假性动脉瘤均为腹部外科手术后急性消化道出血,经内科保守治疗无效而急诊行血管造影及栓塞治疗。其中消化道出血前2例有感染征象,2例腹腔引流液淀粉酶升高。结果11例栓塞后迅速止血;1例消化道出血栓塞胆囊动脉6h后再出血,再次造影发现胃十二指肠动脉残端假性动脉瘤破裂,栓塞胃十二指肠动脉残端后止血。栓塞后复查造影示假性动脉瘤供血动脉完全闭塞,假性动脉瘤未见显影;栓塞术后3例有一过性上腹部疼痛。术后随访3～46个月,无复发及并发症。结论血管造影诊断及经导管栓塞是诊断及治疗胃十二指肠动脉假性动脉瘤迅速、安全、有效的方法。

Objective To discuss the strategy and technique for angiographic diagnosis and transcatheter arterial embolization （TAE） in the treatment of gastroduodenal artery pseudoaneurysms. Materials and Methods All of the 12 patients with Gastroduodenal artery pseudoaneurysms were undergone emergency angiography and interventional therapy because of acute gastrointestinal bleeding after abdominal surgery and failure to conservative treatment. Before the acute onset of the gastrointestinal hemorrhage,two cases had signs of infection,two cases of peritoneal drainage fluid amylase increased. Results Hemostasis was rapidly achieved in 11 patients. One gastrointestinal bleeding patients rebleed 6 hours later after the bile cyst artery embolization because of gastroduodenal artery stump pseudoaneurysm rupture,which was treated successfully with gastroduodenal artery stump embolization. After embolization the supply artery and gastroduodenal artery pseudoaneurysm itself were completely occluded;3 patients experienced transient upper abdominal pain. Follow up was performed in 12 patients for 3-46 months after transcatheter embolization. There were no relapse and complication during follow up. Conclusion Angiographic diagnosis and TAE is an effective and safe method for the patients with gastroduodenal artery pseudoaneuryms.