血管造影及动脉栓塞在急性动脉性出血诊治中的价值

Value of angiography and artery embolization in the diagnosis and treatment of acute artery hemorrhage.

目的评估血管造影及动脉栓塞在急性动脉性出血诊断、治疗中的临床价值。方法回顾性分析36例急性动脉性出血患者血管造影及动脉栓塞治疗资料。通过选择性或超选择性动脉造影来判断有无出血并明确出血部位,对可行栓塞治疗者,用明胶海绵/PVA颗粒/弹簧圈等栓塞材料栓塞出血靶血管。结果 36例出血患者中咯血10例,消化道出血11例,膀胱、肾出血5例,妇科肿瘤出血9例,外科术后出血1例。32例血管造影表现为造影剂喷射、外溢及浓染,阳性率为88.8%;4例阴性表现;阳性病例可行栓塞治疗者28例,其中26例1次栓塞成功,2例2次栓塞成功,4例不可行栓塞治疗者为外科手术治疗提供影像资料。结论动脉造影对动脉性出血定位诊断明确,经导管栓塞出血靶血管止血安全、有效,临床可行性高。

Objective To evaluate the clinical value ofangiography and artery embolization in the diagnosis and treatment of acute artery hemorrhage. Methods The clinical data of 36 patients with acute artery hemorrhage were analyzed retrospectively. Selective angiography and superselective angiography were performed to ascertain the bleeding artery. Then gelfoam, PVA particles and coil were chosen to block target vessels. Results The origins of acute artery hemorrhage included hemoptysis （10 patients）, gastrointestinal tract bleeding （11 patients）, kidney or blad- der bleeding （5 patients）, gynecological tumor bleeding （9 patients） and bleeding after surgery （1 patient）. Angiogra- phy showed contrast agent ejection, overflow and concentrate dye in 32 of the 36 patients, with a positive rate of 88.8%. Twenty-eight of the 32 positive patients can be treated with artery embolization, of which 26 were treated by one embolization procedure and 2 were treated by a second embolization procedure. Four patients were treated by sur- gery. Conclusion It is effective and feasible to use angiography for locating bleeding artery and transcatheter emboli- zation for controlling hemorrhage.