经导管动脉栓塞治疗医源性肝动脉损伤

Transcatheter arterial embolization for iatrogenic hepatic artery injury

目的:探讨医源性肝动脉损伤(Iatrogenic hepatic arterial injuries,IHAI)数字减影血管造影(Digital subtraction angiography,DSA)表现及介入栓塞治疗的疗效。方法:本组23例IHAI患者,先行选择性动脉造影,明确出血部位及性质,然后超选择性动脉栓塞,栓塞材料选择弹簧圈、微弹簧圈、明胶海绵。结果:DSA显示假性动脉瘤14例,对比剂外溢5例,肝动脉胆管瘘3例,肝动脉门静脉瘘1例。栓塞技术成功率100%(23/23),临床成功率87.0%(20/23),2例二次栓塞成功止血,1例二次栓塞后仍间断出血。术后1月内3例分别死于感染性休克、多器官衰竭及突发呼吸心跳骤停,8例于术后3~14月死于多器官衰竭或恶性肿瘤进展,余12例随访1~26月未再出现大出血。术后3 d血红蛋白明显升高(P<0.05),肝功能较术前升高,但统计学无显著差异(P>0.05),术后30 d血红蛋白及肝功能基本恢复到正常范围,未出现其它严重并发症。结论:经导管动脉栓塞术可作为IHAI首选治疗方法。

Objective:To investigate the performance of digital subtraction angiography(DSA)of iatrogenic hepatic artery injury(IHAI)and the effect of interventional embolization therapy.Methods:Twenty-three cases of IHAI were performed selective artery angioraphy for conforming the location and feature of bleeding.And then super-selective arterial embolization were performed.The embolic agents included coils,microcoils,gelfoam.Result:DSA showed 14 cases of pseudoaneurysm,5 cases of extravasation,3 cases of hepatic artery biliary fistula,and 1 case of hepatic artery portal fistula.The success rate of technique was 100%(23/23),and the rate of clinical success was 87.0%(20/23).Two cases were successfully treated by re-embolization,and 1 case was still bleeding after re-embolization.In 1 month after interventional therapy,3 cases died of septic shock,multiple organ failure and sudden respiratory arrest.Eight cases died of multiple organ failure or malignant tumor after 3~14 months of interventional therapy.The remaining 12 cases were followed up for 1~26 months without any major bleeding.Three days after interventional therapy,the hemoglobin was significantly higher compared with pre-intervention therapy(P<0.05),and the liver function was higher,but there was no significant difference compared with pre-intervention therapy(P>0.05).The hemoglobin and liver function were basically recovered to the normal range in 30 days,and there were no other serious complications.Conclusion:Transcatheter arterial embolization can be the preferred treatment for IHAI.