Hepatic artery angiography and embolization for hemobilia after hepatobiliary surgery

Objective To evaluate the effectiveness of hepatic angiography and embolization in the diagnosis and treatment of hemobilia after hepatobiliary surgery.Methods Nine patients had upper gastrointestinal bleeding 7 days to 3 months after surgery. They underwent emergency hepatic artery angiography and were treated by embolization using Gelfoam particles only (8 patients) and Gelfoam particles plus microcoils (1 patient). Results Hepatic artery angiography revealed hepatic artery pseudoaneurysms in 3 patients, diffuse hemorrhage of the hepatic artery branches in 3, right hepatic artery-bile duct fistulas in 2, and hepatic artery-small intestine fistula in 1. Hemobilia was controlled with embolization in 7 patients, of whom 1 had recurrent bleeding 1 day after treatment. During the follow-up, 3 patients died of multiple organ dysfunction syndrome. Two patients whose hemorrhage could not be controlled due to technical reasons died several days later. Conclusion When hemobilia after hepatobiliary surgery is suspected, patients should receive hepatic angiography as a first diagnostic procedure and be treated with minimally invasive procedure of selective embolization of the involved artery as soon as possible.

PLE+GF栓塞治疗肝血管瘤

目的探讨平阳霉素碘油乳剂(PLE)+明胶海绵(GF)颗粒栓塞治疗肝血管瘤的疗效和价值。方法采用Seldinger技术经股动脉穿剌插管,超选择至血管瘤供血动脉,对15例肝海绵状血管瘤(CHL)注入PLE至血管瘤体完全充填,并用GF颗粒栓塞供血动脉。定期观察瘤腔碘油充填情况、疗效和并发症。结果PLE+GF栓塞治疗后,碘油存积好,血管瘤体积明显缩小,无严重并发症。结论PLE+GF栓塞治疗肝血管瘤具有疗效好、创伤小、并发症少等优点。

选择性动脉造影栓塞在腹部创伤中的应用

目的 探讨选择性动脉造影栓塞 (AE)在腹部和骨盆创伤出血的治疗效果。方法 1997～ 2 0 0 3年应用AE治疗腹部创伤病人 ,将其分为三类 :Ⅰ类 2 4例 ,腹部外伤后脏器出血。Ⅱ类 5例 ,腹部外伤手术后出血。Ⅲ类 4例 ,骨盆手术前先作髂内动脉栓塞 ,以预防手术时出血。对治疗和结果作回顾性分析。结果 3 3例病人造影 66处 ,栓塞 41处 ,有效率 97 0 % ,死亡 1例 (3 0 % )系栓塞无效。 2例直接并发症分别为异位栓塞和血管内膜损伤 ,均治愈。结论 AE可减少腹部和骨盆创伤出血 ,手术止血困难、术后出血或预防骨盆手术前出血 ,也是可选择的手段 ;