摘要
目的探讨经导管动脉栓塞术(TAE)治疗纵隔出血的临床应用价值。方法收集采用TAE术治疗的4例纵隔出血患者临床资料。术前作胸部CT平扫或增强检查,治疗时先行主动脉造影并探寻出血动脉,用微导管超选择至出血动脉后分别用明胶海绵、聚乙烯醇(PVA)颗粒或两者联合作栓塞,术后胸部CT平扫观察栓塞治疗效果并进行随访。结果术前CT检查确定4例患者均为纵隔出血。术中经主动脉造影和探寻出血动脉发现,4例患者出血分别源自右侧第5肋间动脉纵隔分支、左侧支气管动脉分支、胸主动脉的食管动脉纵隔分支及左膈下动脉纵隔分支,给予明胶海绵及PVA颗粒后造影见对比剂外溢及动脉瘤征象消失。术后复查胸部CT显示4例患者纵隔血肿范围均缩小,随访6个月时3例未发生再出血,1例术后2个月病死于原发病。结论 TAE术治疗纵隔出血具有创伤小、止血直接迅速、疗效确切等优点,为临床治疗提供了一种新手段。
Objective To discuss the clinical application of transcatheter artery embolization in treating mediastinal hemorrhage. Methods The clinical data of four patients with mediastinal hemorrhage, who were treated with transeatheter artery embolization at authors＇ hospital, were collected. Plain or contrast-enhanced CT scan of chest was performed before operation. First, aortic angiography was employed to find out the bleeding arteries, then, super-selective catheterization of the bleeding artery with a microcatheter was conducted, finally, gelatin sponge and/or polyvinyl alcohol （PVA） particles were used to obstruct the bleeding artery. After the embolization, plain CT scan of chest was adopted to check the embolization result. All the patients were followed up. Results Preoperative CT scan confirmed the diagnosis of mediastinal hemorrhage in all 4 patients. Intraoperative aortic angiography with the searching of bleeding arteries revealed that in the 4 patients the bleeding originated from the mediastinal branch of the fight fifth intercostal artery （n=1）, the branch of left bronchial artery （n=1）, the mediastinal branch of esophageal artery that originated from the thoracic aorta （n=1） and the mediastinal branch of the left inferior phrenic artery （n=1）. Angiography performed immediately after the injection of gelatin sponge and/or PVA particlesshowed that the signs of contrast agent extravasation and aneurysm disappeared. Postoperative chest CT reexamination indicated that the size of mediastinal hematoma was reduced in all 4 patients. Follow-up examination performed at 6 months after the treatment revealed that no recurrence of bleeding was observed in 3 patients, and one patient died of the primary disease in two months after the treatment. Conclusion For the treatment of mediastinal hemorrhage, transcatheter artery embolization has certain advantages, such as less trauma, direct and rapid hemostasis, reliable curative effect, etc. This technique provides a new means for clinical treatment.
出处
《介入放射学杂志》
CSCD
北大核心
2016年第11期954-957,共4页
Journal of Interventional Radiology
基金
湖北省自然科学基金面上项目(2013CFB256)
关键词
纵隔
出血
经导管动脉栓塞术
mediastinum
hemorrhage
transcatheter artery embolization
