摘要
目的 :讨论胆道出血的数字减影血管造影表现 ,经导管超选择性双重栓塞治疗胆道出血的疗效。方法 :采用Seldinger’s技术 ,经股动脉置入导管 ,行选择性肠系膜上动脉、腹腔动脉、肝动脉数字减影血管造影。经导管超选择栓塞出血动脉出血点的远端和近端 ,栓塞后造影了解栓塞效果。结果 :12例胆道出血选择性肝动脉血管造影的表现 ,8例表现为肝内假性动脉瘤 ,2例为肝癌并发动脉 门脉瘘 ,2例肝部分切除术后出现肝内片状造影剂溢出影。 2例腹腔动脉造影阴性 ,而选择性肝动脉血管造影均显示病灶 ;10例经导管用明胶海绵加弹簧圈或微弹簧圈栓塞治疗 1次 ,出血停止 ,随访无再出血。 2例用明胶海绵栓塞 ,其中 1例栓塞治疗后 3周 ,再次发生出血 ,用明胶海绵加弹簧圈栓塞出血停止。结论 :选择性肝动脉血管造影是诊断胆道出血的关键 ,超选择性双重栓塞出血动脉的远端和近端是治疗胆道出血安全有效的止血方法 。
Objective:To discuss the DSA features of hemobilia and the efficacy of transcatheter arterial double embolization for hemobilia.Methods:The catheter was introduced into SMA,CA,HA respectively to perform angiography.When the bleeding artery was documented,the proximal and distal area of the bleeding site was embolized by gelfoam and spring coil through catheter.Results:Angiograms of 12 cases of hemobilia showed pseudoaneurysms (n=8), arterial portal fistula caused by hepatic cancer(n=2),and contrast medium leakage from arterial into hepatic parenchyma following partial hepatic resection(n=1).In 2 cases the celiac axis angiography failed to demonstrate hemorrhage,but this was demonstrated by hepatic angiography.10 cases embolized by spring coil with gelfoam stopped bleeding and no further bleeding occurred at follow up.One of two cases with gelfoam embolization recurred hemorrhage three weeks later and then underwent embolization of spring coil with gelfoam for hemostasis.Conclusion:Selective hepatic angiography is the key to diagnose hemobilia.Transcatheter arterial double embolization of the proximal and distal site of the bleeding vessel is a safe and effective method for hemobilia,efficacy of hemostasis with spring coil and gelfoam is superior to that with gelfoam alone.
出处
《放射学实践》
2001年第3期166-169,共4页
Radiologic Practice
