医用胶栓塞肝动脉假性动脉瘤16例临床效果

Percutaneous trans-microcatheter hepatic arterial embolization with medical glue for hepatic artery pseudoaneurysm: observation of its clinical effect in 16 patients

目的探讨FAL医用胶经微导管肝动脉栓塞治疗肝动脉假性动脉瘤(HAPA)的技术安全性和临床疗效。方法回顾性分析2014年2月至2016年9月采用FAL医用胶栓塞治疗的16例经肝动脉造影确诊为HAPA患者的临床资料。所有患者均经微导管超选至靶血管,匀速注入FAL医用胶-碘化油混合乳剂进行栓塞治疗。观察栓塞成功率、手术时间,术后第1、3、14、30 d复查天冬氨酸转氨酶(AST)、谷氨酸转氨酶(ALT)、间接胆红素(IBIL)、总胆红素(TBIL)等肝功能指标。结果 16例患者靶血管均成功栓塞,手术成功率100%(16/16)。FLA医用胶-碘化油混合剂平均用量0.9(0.5～1.8) mL,平均手术时间22(15～32) min。术后瘤体及对比剂外溢均消失,责任动脉呈残根状,无异位栓塞。5例出现不同程度栓塞后综合征表现,对症处理后症状缓解。与术前比较,术后1、3 d AST、ALT、IBIL、TBIL指标无明显变化(P>0.05),术后14、30 d明显改善(P<0.05)。出院前复查肝脏血管彩色超声检查,均未见瘤体血流征象。结论 FAL医用胶超选择栓塞治疗HAPA显效迅速、安全、并发症少,对肝功能无严重影响。

Objective To discuss the technical safety and clinical efficacy of percutaneous transmicrocatheter hepatic arterial embolization with FAL medical glue for hepatic artery pseudoaneurysm （HAPA）. Methods The clinical data of 16 patients with angiographyconfirmed HAPA, who received hepatic arterial embolization with FAL medical glue during the period from February 2014 to September 2016 at authors＂ hospital, were retrospectively analyzed. First, the target vessel was super-selectively catheterized with a mierocatheter, then, the mixed emulsion of FAL medical glue and iodized oil was injected with a stable injection rate to embolize the HAPA. The success rate of embolization and the time spent in surgery were calculated, and at one, 3, 14 and 30 days after the treatment the liver functions, including AST, ALT, IBIL, TBIL, etc., were reexamined. Results The target vessel was successfully obstructed in all the 16 patients, the success rate of operation was 100% （16/16）. The average used dosage of the mixed emulsion of FAL medical glue and iodized oil was 0.9 mL （0.5-1.8 mL） and the mean time spent in surgery was 22 rain （15-32 rain）. After the embolization, both the aneurysm shadow and contrast extravasation shadow disappeared, the preoperative responsible artery was manifested as a remnant root. No ectopic embolism occurred. Manifestations of post- embolization syndrome in different degrees were observed in 5 patients, which were improved after symptomatic treatment. Compared with the preoperative ones, the postoperative AST, ALT, IBIL, TBIL levels tested at one and 3 days after the embolization showed no obvious changes （P〉0.05）, but these indexes tested at 14 and 30 days after the embolization were significantly improved （P〈 0.05）. Reexamination of hepatic vascular color ultrasound before discharge from hospital indicated that no signs of tumor blood flowing could be detected. Conclusion For the treatment of HAPA, super-selective embolization of the target vessel with FAL medical glue is safe and quickly effective with less complications, besides, it has no significant effect on liver functions.（J Intervent Radiol, 2018, 27： 959-962）