选择性动脉栓塞治疗胆道大出血
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詹世林 E-mail:shilinzhan@tom.com

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Selective artery embolization for massive hemobilia
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    摘要:

    目的: 探讨选择性动脉栓塞对胆道大出血的处理效果。
    方法:采用Seldinger技术穿刺右侧股动脉,将导管放置于肝动脉后造影,显示肝脏出血部位,然后将微导管置于出血的分支血管,注入栓塞剂进行止血。
    结果:全组23例胆道大出血(13例为肝外伤术后、6例为肝胆管结石病术后、4例为原发性肝癌),造影显示肝右动脉分支出血12例,肝左动脉分支出血5例,肝左右动脉分支均有出血6例。肝动脉分支中断、动脉瘤及造影剂外溢与胆道显影是其典型表现。23例均顺利完成选择性出血血管栓塞,其中多个出血点分支血管栓塞11例。止血成功率100%。无继发出血及开腹止血病例,无出血死亡病例。全组随访0.5~3.0年,无胆道再出血及栓塞所致并发症。
    结论:选择性动脉栓塞是胆道大出血的一种有效、简便、微创的方法。

    Abstract:

    Objective:To evaluate the hemostasis efficacy of selective artery embolization for treatment of patients with massive hemobilia.
    Methods:Adopting the Seldinger technique, transcatheter selective arterial embolization was performed in twenty-three patients with massive hemobilia caused by liver trauma, hepatic calculus and hepatocellular carcinoma.
    Results:Of the 23 cases, 12 cases had bleeding from right hepatic artery branch, 5 from left hepatic artery branch and 6 from both right and left hepatic artery branches as shown by digital subtraction angiography (DSA). Hepatic artery break off, false aneurysm,contrast medium overflow and bile duct display were the typical angiographic signs of the patients with massive hemobilia. There were twelve patients with single bleeding focus and eleven with multi-bleeding foci of hepatic artery branch. All patients successfully underwent selective artery embolization and the bleeding stopped immediately.  There were no cases of rebleeding, no cases were converted to laparotomy and no mortality caused by hepatic artery embolization in this series; and all the 23 patients are well in a half to three years of follow-up.
    Conclusions:Selective arterial embolization is an effective and simple hemostasis method for patients with massive hemobilia.

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詹世林|陈建雄|彭林辉|霍枫|陆树桐.选择性动脉栓塞治疗胆道大出血[J].中国普通外科杂志,2011,20(2):169-171.
DOI:10.7659/j. issn.1005-6947.2011.02.015

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  • 收稿日期:2010-05-04
  • 最后修改日期:2010-09-14
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  • 在线发布日期: 2011-02-15