摘要
目的评价经导管动脉栓塞术(TAE)治疗腹部外科术后迟发性出血的临床应用价值。方法回顾性分析2010年5月至2019年6月采用TAE诊断治疗的腹部外科术后迟发性出血患者23例。术中动脉造影明确出血责任动脉,对动脉主干出血予以弹簧圈栓塞动脉远段和近段,对动脉末梢出血予以明胶海绵颗粒或明胶海绵颗粒联合弹簧圈栓塞。术后随访至患者治愈出院或院内死亡。结果23例患者中造影表现阳性22例,阴性1例,阳性率为95.7%。阳性患者中动脉假性动脉瘤形成8例,动脉破裂伴对比剂外溢14例。所有阳性患者均接受进一步TAE治疗,术后治愈17例,死亡3例,复发2例,临床有效率为86.4%。术后1例死于肝衰竭,2例死于多脏器衰竭,2例复发患者再次TAE治疗后治愈出院,所有患者均未发生胃肠坏死和胃肠穿孔等栓塞并发症。结论动脉造影结合TAE诊断腹部外科术后迟发性出血阳性率高,治疗效果确切,可作为首选方法。
Objective To assess the clinical application value of transcatheter arterial embolization(TAE)in treating delayed hemorrhage after abdominal surgery.Methods The clinical data of a total of 23 patients,who received TAE for delayed hemorrhage after abdominal surgery during the period from May 2010 to June 2019 at authors’hospital,were retrospectively analyzed.Angiography was performed to identify the responsible artery causing bleeding.Embolization with coils was adopted to occlude the distal and proximal segments of the bleeding artery trunk.For the hemorrhage of peripheral arteries,TAE with gelatin sponge particles or combination use of gelatin sponge particles plus coils was carried out.Follow-up observation was conducted till the patients were cured and discharge from hospital or till the patients died in hospital.Results Among the 23 patients,positive angiographic findings were seen in 22 and negative angiographic findings in one,with a positive rate of 95.7%.Of the 22 patients with positive angiographic findings,pseudoaneurysm formation was detected in 8 and arterial rupture with contrast agent extravasation in 14.All the 22 patients with positive angiographic findings were further treated with TAE.After treatment,cure was achieved in 17 patients,death occurred in 3 patients,and 2 patients had a relapse.The clinical effective rate was 86.4%.After TAE,one patient died of hepatic failure,two patients died of multiple organ failure.Two patients with recurrence were treated with TAE again and were cured when discharged from hospital.No complications of embolization such as gastrointestinal necrosis or gastrointestinal perforation occurred in all patients.Conclusion Angiography combined with TAE has high positive rate and reliable therapeutic effect in diagnosing and treating delayed hemorrhage after abdominal surgery.Therefore,it is the preferred method for delayed hemorrhage after abdominal surgery.
作者
甘振
陈涛
冯玉明
管敬
周良
GAN Zhen;CHEN Tao;FENG Yuming;GUAN Jing;ZHOU Liang(Department of Interventional Radiology,Second Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu Province 210011,China)
出处
《介入放射学杂志》
CSCD
北大核心
2020年第9期934-938,共5页
Journal of Interventional Radiology
关键词
出血
血管造影
经导管动脉栓塞术
hemorrhage
angiography
transcatheter arterial embolization
