摘要
目的 通过数字减影血管造影(DSA)寻找肋间动脉隐匿出血点并精准栓塞,探讨经导管肋间动脉栓塞术(TAE)治疗肋间动脉出血的有效性及安全性。方法 回顾性分析2021年12月至2023年12月河南省直第三人民医院放射介入科和郑州大学第一附属医院介入治疗中心肋间动脉出血患者16例,男10例,女6例,年龄31~89岁,平均(59.00±18.31)岁。道路交通伤8例,坠落伤5例,医源性损伤1例,其他外伤2例。收集并分析患者肋间动脉损伤的程度和范围,造影明确出血点后精准栓塞止血,并记录技术成功率、临床成功率及相关并发症。结果 造影共发现39支责任血管,使用本方法治疗的16例患者均达到了有效止血效果,栓塞治疗有效率达到100%。16例肋间动脉出血患者中,可见明显造影剂外溢10例,可见假性动脉瘤形成6例。责任血管39支均为肋间动脉。对16例造影剂肋间动脉出血患者以明胶海绵颗粒单独或联合弹簧圈行TAE,均达到有效止血。术后3 d复查血红蛋白平均(105.30±4.21)g/L,较术前显著回升,差异有统计学意义(t=9.74,P=0.013)。除1例失访患者外剩余患者随访3个月后均未再次出血,术后不良反应轻微,无严重并发症。结论 对于内科非手术治疗无效的肋间动脉出血,TAE止血效果明确,安全、有效、微创,具有较高的临床应用价值。
Objective To investigate the effectiveness and safety of transcatheter intercostal artery embolization(TAE)in the treatment of intercostal artery bleeding by using digital subtraction angiography(DSA)to locate and precisely embolize occult bleeding sites.Methods A retrospective analysis was performed on 16 patients with intercostal artery bleeding treated between December 2021 and December 2023 at the Department of Interventional Radiology,the Third People′s Hospital of Henan Province,and the Interventional Treatment Center,the First Affiliated Hospital of Zhengzhou University.The cohort included 10 males and 6 females,aged 31-89 years,with a mean age of(59.00±18.31)years.Causes of injury included road traffic accidents(8 cases),fall injuries(5 cases),iatrogenic injury(1 case),and other traumas(2 cases).The severity and extent of intercostal artery injury were evaluated,and bleeding sites were identified using angiography.Hemostasis was achieved via precise embolization,and technical success rate,clinical success rate,and associated complications were recorded.Results A total of 39 responsible vessels were identified through angiography,all of which were intercostal arteries.Effective hemostasis was achieved in all 16 patients treated with TAE,resulting in an embolization success rate of 100%.Among the 16 patients,10 cases exhibited obvious extravasation of contrast agent,and 6 cases showed pseudoaneurysm formation.Gelatin sponge particles alone or combined with coils were used for embolization.The average hemoglobin level was significantly improved from preoperative levels to(105.30±4.21)g/L at 3 days postoperatively(t=9.74,P=0.013).During a 3-month follow-up,except for one patient lost to follow-up,there were no cases of recurrent bleeding,and postoperative adverse reactions were mild with no severe complications reported.Conclusion For intercostal artery bleeding unresponsive to non-surgical medical treatment,TAE provides effective hemostasis with high safety,efficacy,and minimal invasiveness,making it highly valuable for clinical application.
作者
李照军
丁立山
陈清亮
申猛
梁昊
郑鸣
马骥
李腾飞
LI Zhao-jun;DING Li-shan;CHEN Qing-liang;SHEN Meng;LIANG Hao;ZHENG Ming;MA Ji;LI Teng-fei(Department of Interventional Radiology,the Third People′s Hospital of Henan Province,Zhengzhou 450006,Henan,China;不详)
出处
《广东医学》
2025年第4期542-546,共5页
Guangdong Medical Journal
基金
河南省医学科技攻关计划联合共建项目(LHGJ20210255)
河南省中青年卫生健康科技创新杰出青年人才培养项目(YXKC2022029)。
关键词
血胸
出血
经动脉栓塞术
急诊
hemothorax
bleeding
transcatheter embolization
emergency
