经皮肝穿胆道引流术后肝动脉出血的介入治疗

Interventional therapy of hepatic arterial hemorrhage occurred after percutaneous transhepatic biliary drainage

目的分析经皮肝穿胆道引流术后肝动脉出血的原因及临床表现,总结诊疗经验,以降低其发生率及病死率。方法 2007年6月至2010年6月622例接受经皮肝穿胆道引流术患者中有11例患者肝动脉出血(均经血管造影证实),其中胆道出血6例,腹腔出血3例,胆道及腹腔合并出血2例。该文回顾性分析肝动脉出血患者的临床表现及治疗结果。结果 11例患者均予以弹簧圈及明胶海绵栓塞肝动脉出血分支,栓塞后10例患者出血停止,病情缓解出院,1例患者出血停止,但肝肾功能持续恶化,死亡。结论经皮肝穿胆道引流术后出现肝动脉出血者较少见,但病情多危重,行肝动脉造影及栓塞治疗是一项安全有效的治疗手段,应早期发现,早期治疗。

Objective To analyze the causes and clinical manifestations of hepatic arterial hemorrhage which occurred after percutaneous transhepatic biliary drainage and to summarize the practical experience in its diagnosis and treatment in order to decrease its incidence and mortality.Methods During the period from June 2007 to June 2010,percutaneous transhepatic biliary drainage was carried out in 622 cases,of which DSA-proved postoperative hepatic arterial hemorrhage occurred in 11,including bile duct hemorrhage（n = 6）,abdominal cavity bleeding（n = 3） and combination bleeding of bile duct and abdominal cavity（n = 2）.Interventional embolization of the bleeding branches of hepatic artery with Gelfoam and coils was carried out in all 11 patients.The clinical data such as clinical manifestations and therapeutic results were retrospectively analyzed.Results After interventional embolization therapy for postoperative hepatic arterial hemorrhage the bleeding stopped in ten patients,who were discharged from hospital when the clinical conditions were alleviated.The remaining one patient died of sustained deterioration in hepatic and renal functions although the bleeding was ceased.Conclusion Though hepatic arterial hemorrhage occurred after percutaneous transhepatic biliary drainage is a rare complication,it is dangerous and fatal.Hepatic arterial angiography together with interventional embolization is a safe and effective therapy for hepatic arterial hemorrhage.