外科术后腹部出血的血管造影诊断及介入治疗

Angiographic diagnosis and interventional therapy for post-operative hemorrhage in abdomen secondary to surgery

目的探讨外科术后腹部出血（包括腹腔、腹膜后、消化道）的数字减影血管造影（digital subtraction angiography，DSA）表现和介入治疗的临床价值。方法2003年6月至2009年6月间，24例外科术后怀疑腹部出血的患者接受了DSA造影检查和介入治疗。回顾性分析外科术后腹部出血的数字减影血管造影表现和介入治疗方法，比较介入术前和术后3d血红蛋白、红细胞压积、血压和心率变化。计量资料使用均数±标准差（x±s）表示，使用配对t检验对相关指标进行比较，统计软件使用SPSS11．0。结果经DSA造影检查后，24例患者均明确了出血原因和出血部位。其中22例进行介入治疗后出血即刻停止（92％，95％CI：63％～99％）且30d内未复发，2例疗效不佳行外科手术治疗。经介入治疗的患者未出现介入相关并发症。术后3d患者血红蛋白、红细胞压积、收缩压和舒张压增高（t=7．564，P=0．000；t=6．616，P=0．000；t=6．051，P=0．000；t=8．579，P=0．000），心率降低（t=11．050，P=0．000）。结论DSA能够明确外科术后腹部出血的原因和部位；介入栓塞治疗安全、有效，具有重要的临床应用价值，值得大力推广。

Objective To discuss the clinical value of digital subtraction angiography （DSA） and interven- tional therapy in the abdominal exsanguinations including intra-abdominal hemorrhage, retroperitoneal hemorrhage and gastrointestinal hemorrhage secondary to surgery, nelhod From June 2003 to June 2009, a total of 24 patients with doubtful abdominal exsanguinations underwent DSA examination and received interventional therapy. The imaging of DSA and the efficacy were retrospectively analyzed. The hemoglobin, hemtocrit, blood pressure, and heart rate before and 3 days after operation were compared. The measurement data were analyzed using paired- samples t -test, and the SPSS version 11.0 software was used for statistical analysis. Results The diagnosis of causes and site of post-operative bleeding were entirely depended upon DSA examinations. All the patients accepted interventional therapy in the same session. Twenty-two patients （92%, 95%CI： 63% - 99% ） got rid of bleeding immediately without recurrence in 30 days, and two patients underwent re-surgical intervention because of bleeding recurrence within 24 hours. There were no complications of intervention found. The increases in levels of hemoglobin, hematocrit and blood pressures were observed （t = 7.564, P = 0.000; t = 6.616, P = 0.000; t = 6.051, P = 0.000; and t = 8.579, P = 0.000, respectively）, and the heart rate was decreased （t = 11.050, P = 0. 000）. Conclusions The DSA can determine the causes and the sites of post-operative bleeding, and the interventional therapy is safe and effective with great clinical values, being worthy to extending in a large scale of application.