血管内栓塞治疗腹部急性大出血

Endovascular embolization for acute abdominal bleeding

目的探讨血管内栓塞对腹部急性大出血的治疗价值。方法对66例腹部急性大出血的患者采用介入技术,行选择性及超选择性动脉造影和血管内栓塞术,其中胃出血28例,肠道出血12例,子宫出血17例,肝出血3例,肾出血2例,腹部术后急性腹腔内出血4例。结果 66例患者经一次选择性动脉造影获得明确诊断65例,诊断阳性率98.5%。选择性动脉造影显示对比剂外溢出血直接征象36例,直接征象阳性率54.5%。发现假性动脉瘤13例,肿瘤供血动脉及肿瘤染色21例,子宫动脉增粗及分支增多12例,血管结构不良出血1例。诊断明确后,一次性血管内栓塞治疗后均成功止血。1例消化道出血患者,介入栓塞治疗4 d后复发出血,经第2次选择性动脉造影及介入栓塞侧支供血后成功止血。一次性栓塞治疗成功率98.5%。结论选择性动脉造影及血管内栓塞术对急性腹部出血可明确出血部位,继而达到迅速有效止血的目的,是一种安全易行、迅速有效的诊断与治疗手段。

Objective To explore the clinical significance of endovascular embolization for acute abdominal bleeding. Methods A total of 66 patients with acute abdominal bleeding received arteriography and endovascular embolization, among whom 28 had gastric bleeding, 12 intestinal bleeding, 17 uterine bleeding, 3 hepatic bleeding, 2 renal bleeding and 4 postoperative acute bleeding. Results With selective arteriography, 65 cases were confirmed. The rate of posi- tive diagnosis was 98.5%. The direct sign of bleeding, extravasation of contrast media, was shown in 36 cases, with a positive rate of 54.5%. Pseudoaneurysm was indicated in 13 cases. The tumor blood feeding branches and tumor stai- ning were seen in 21 cases. The thickened uterine arteries and increased number of branches were revealed in 12 cases. The vascular dysplasia was demonstrated in 1 case. The instant hemostasis was achieved in all diagnosed cases by the first embolization without complication. However, one patient with gastrointestinal bleeding relapsed 4 days after embo- lization and was successfully treated by the second embolization. The success rate of hemostasis was 98. 5%. Conclusion Selective angiography and intravascular embolization can accurately locate the acute bleeding site and achieve rapid hemostasis, which is a safe, quick and cost-effective method.