选择性出血动脉栓塞在外伤性脾脏破裂出血处理中的应用

Selective Arterial Embolization in the Treatment of Traumatic Splenic Rupture

目的探讨选择性出血动脉栓塞在处理外伤性脾脏破裂出血中的效果。方法采用Seldinger技术穿刺右侧股动脉,把导管放至脾动脉后造影,显示脾脏出血部位,然后把微导管放至出血(叶、段)血管,注入PVA、明胶海绵颗粒等栓塞剂进行止血。结果44例脾动脉造影显示脾外伤(夏氏分级)Ⅱ级23例,Ⅲ级19例,Ⅳ级2例。44例均顺利完成选择性出血血管栓塞,其中脾叶动脉血管栓塞13例,脾段动脉血管栓塞31例;1次栓塞成功35例,再次栓塞成功9例。无继发出血及开腹手术病例,无死亡病例。术后1周血红蛋白、红细胞压积恢复正常。44例随访0.5～1年,无再出血、严重感染及其他并发症发生。结论选择性脾动脉出血血管栓塞是治疗外伤性脾破裂出血的一种有效、简便、微创的方法。

Objective To evaluate the hemostatic efficacy of selective arterial embolization for the treatment of traumatic splenic rupture.Methods Totally 44 patients with traumatic splenic rupture were enrolled in this study.With Seldinger technique,a catheter was introduced into the splenic artery via the right femoral artery for angiography.Once the bleeding sites were identified,microcatheters were placed into the hemorrhagic vessels to control the bleeding with PVA or gelatin sponges.Results The angiography of the spleen showed grade Ⅱ splenic rupture（Xia＇s classification）in 23 patients,grade Ⅲ in 19,and grade Ⅳ in 2.Selective arterial embolization was completed in all of the 44 cases.In the patients,embolizations of the lobar and segmental arteries were performed on 13 and 31 cases respectively.The surgery was completed in the first attempt in 35 cases,and in the second attempt in 9.Neither secondary hemorrhage nor open surgery occurred in this series.No patient died after the operation.One week after the treatment,blood examination showed normal levels of hemoglobin and hematocrit in all the cases.The patients were followed up for 0.5 to 1 year,during which no one had hemorrhage,serious infection or other complications.Conclusions Selective arterial embolization is an effective,simple and minimally invasive therapy for patients with traumatic splenic rupture.