摘要
目的探讨肝动脉造影及经动脉栓塞在经皮肝穿刺胆道引流术(PTCD)后动脉出血诊断和治疗中的价值。方法回顾性分析2013年1月~2015年7月11例PTCD术后动脉出血患者临床资料,1例表现为出血性休克,急诊行肝动脉造影;6例拟行胆道支架置入,撤出引流管后见引流道鲜血涌出伴剧烈腹痛,将引流管送回原位行肝动脉造影;3例引流管反复引出血性胆汁,1例术后间断黑便且血红蛋白减低,均经保守治疗无效后行肝动脉造影。结果肝动脉造影表现为假性动脉瘤4例,肝动脉胆管瘘7例。9例患者责任动脉采用弹簧圈栓塞,2例采用弹簧圈及明胶海绵栓塞。术后所有患者血红蛋白稳定,出现不同程度转氨酶增高、发热及腹痛等表现,对症治疗后好转,6例1周后成功行胆道支架置入。术后患者随访5~16个月,均无再次胆道出血。结论肝动脉造影及经动脉栓塞损伤小、安全有效,可作为治疗PTCD术后肝动脉出血的首选方法。
Objective To investigate the finding of hepatic angiography and effectiveness of transeatheter arterial embolization （TAE） for bleeding of hepatie artery after pereutaneous transhepatie eholangial drainage （PTCD）. Methods 11 patients were enrolled from January 2013 to July 2015. The clinical manifestations included that hemorrhagie shock （ n = 1 ）, severe abdominal pain and bleeding along PTCD tract after removing the drainage tube over a wire for implantation of metal stents, the tube was put back and hepatic arteriography was performed immediately （ n = 6 ）, intermittent hemorrhagic bile from the drainage tube （ n = 3 ） and recurrent melena with decrease of hemoglobin （ n = 1 ）. Results The angiagraphy demonstrated pseudoaneurysm （ n = 4） and hepatic arterio-biliary fistula （ n = 7）. The materials used for TAE included coil （ n = 9） and coil plus gelatin sponge （ n = 2）. In all patients, bleeding was stopped right after TAE. Metal stents were successfully implanted for 6 patients after one week. No sign of recurrent bleeding was observed during 5 - 16 months following-up. Complications associated with TAE included transient ab- dominal pain, fever and elevation of liver aminotransferases, whieh could be alleviated by symptomatic treatment. Conclusion Hepatic angiography and TAE are minimally invasive, safe and effective approach, which can be performed firstly for the diagnosis and treatment of arterial bleeding after PTCD.
出处
《医学影像学杂志》
2017年第11期2135-2138,共4页
Journal of Medical Imaging
关键词
肝动脉造影
经动脉栓塞
肝动脉出血
经皮肝穿刺胆道引流术
Hepatic angiography
Transeatheter arterial embolization
Bleeding of hepatic artery
Pereutaneous transhepatic eholangial drainage
