胆道大出血的导管治疗

TRANS-CATHETER EMBOLIZATION IN THE TREATMENT OF MASSIVE BILIARY HEMORRHAGE

目的 探讨运用选择性动脉造影和栓塞术对胆道大出血的诊断和治疗价值。方法 运用Seldinger技术对 11例胆道大出血患者进行急诊选择性肝动脉及其分支造影和栓塞术 ,栓塞材料运用明胶海绵粒或明胶海绵粒加方纱线段。结果 7例胆道术后、1例腹腔镜胆囊摘除术后、1例肝脏外伤后及 2例巨块型肝癌破裂后大出血的患者 ,行选择性肝动脉及其分支造影有 9例发现异常 ,表现为造影剂外溢征 ( 9例 ) ,肿瘤血管和肿瘤染色征 ( 2例 )和假性动脉瘤形成( 4例 )。经导管栓塞术后 ,11例患者出血均停止 ,2例导管治疗 48小时后复发大出血。结论 胆道大出血的急诊导管治疗是一种快速、安全、有效的方法 ;导管治疗后保持胆道引流的通畅也很重要。

Objective To investigate the diagn os tic and therapeutic value of selective angiography and embolization treatmen t in massive biliary hemorrhage in emergency. Methods Eleven cases of massive biliary bleedi ng were selectively angiographied and embolized with thread segment and gelatin sponge grain by Seldinger technique in emergency. Results Massive biliary bleeding in this series included bleeding after biliary surgery (7), post-laparoscopic cholecystectomy bleeding (1), bleeding from traumatic injury to liver (1), and rupture of hug e hepatic cancer (2). There were 9 cases with abnormal angiographic findings in cluding contrast medium leakage (9), tumor vessels and tumor tissue staining (2) and signs of pseudo-aneurysm formation (4). All the bleedings were stopped af ter emergency intervention but 2 cases with recurrent massive bleeding after 48 hours. Conclusion Emergency trans-catheter em bolization treatment is an effective and safe method for biliary massive hemorr hage. It is also important to keep the biliary tract unobstructed.