创伤性动脉损伤的血管内介入治疗

Percutaneous Intravascular Interventional Treatment of Traumatic Arterial Injuries

目的探讨创伤性动脉损伤介入治疗的临床疗效和安全性。资料与方法 38例创伤性动脉损伤患者,包括骨盆骨折24例,颅底颌面部骨折12例,颈胸部外伤2例。所有患者经保守治疗无效和/或难以耐受外科手术,在外伤后1～24h内行急诊动脉造影,根据动脉损伤部位,选用明胶海绵颗粒和细条、不锈钢圈、可脱球囊及支架进行治疗。结果除1例患者因休克时间长在造影过程中心跳呼吸骤停未行介入治疗外,其余37例均在2h内完成介入治疗,成功率为97%(37/38),出血患者栓塞后活动性出血停止,失血性休克得到控制。2例盆腔出血伴左髂股动脉急性闭塞的患者同时行支架置入后血管开通,肢体得以保存;1例刀刺伤致椎动脉断裂、假性动脉瘤形成的患者行球囊封堵及弹簧钢圈栓塞后治愈;1例无名动脉假性动脉瘤置入覆膜支架一枚后假性动脉瘤被隔绝;1例出现弥漫性血管内凝血(DIC)并死亡。结论血管内介入治疗是创伤性动脉损伤的安全、有效、简便的急救措施。

Objective To explore the clinical value and safety of percutaneous intravascular interventional treatment for traumatic arterial injuries.Materials and Methods Thirty-eight cases of traumatic arterial injuries,including 18 cases of pelvic fracture,12 cases of basicranial and maxillofacial fracture,2 cases of neck and thorax injury,who failed of conventional therapy or operation underwent urgent angiography and intravascular interventional in 24 hours after trauma.The target arteries were intravascular therapy with glutin sponge,steel coils,detachable balloons or stents.Results Except 1 case suffered from long term shock died of cardiopulmonary arrest in the course of angiography,the other 37 cases were successfully underwent intravascular therapy within 2 hours with success rate of 97%（37 /38）.Bleeding was controlled immediately after embolization.Two cases of traumatic hemorrhage combined with acute occlusion of left iliac-femoral artery were recanalized successfully after stent implantation,and low extremities were cured.Pseudoaneurysm because of vertebral artery rupture in 1 case was cured with detachable balloon and coils.One case of innominate artery pseudoaneurysm cured by endovascular isolation using stent-graft placement.One case died of DIC.Conclusion Intravascualr treatment is a safe and effective therapeutic method with minimal invasion for traumatic arterial injuries.