髂内动脉栓塞术治疗放射性膀胱炎所致血尿

目的探讨双侧髂内动脉栓塞术在治疗放射性膀胱炎所致血尿中的作用。方法10例放射性膀胱炎伴血尿经止血治疗后无效,接受了双侧髂内动脉栓塞,其中包括3例宫颈癌和7例直肠癌放疗后出现放射性膀胱炎。所有患者均采用明胶海绵颗粒栓塞髂内动脉。结果10例患者栓塞术后24h内肉眼血尿明显减轻,肉眼血尿消失时间为1～7d(平均4d),随访期间1例患者再出血,经再次栓塞后出血停止。8例患者出现臀部胀痛,考虑为栓塞臀上动脉所致,其余未见明显并发症。结论髂内动脉栓塞治疗放射性膀胱炎伴血尿是安全有效的方法。     

髂内动脉栓塞术治疗放射性膀胱炎出血所致腓总神经损伤一例

临床资料 患者女,54岁.因"阵发性血尿1年,加重10 d"入院.4年前因宫颈癌行放射治疗,其后经妇科及各种检查未发现肿瘤复发和转移.近年未,患者多次出现血尿,并伴尿频、尿急、尿痛、排尿困难.10 d前,头晕、乏力感明显,肉眼血尿加重,尿中见大量血凝块,排尿困难,血红蛋白58g/L.     

髂内动脉化疗栓塞治疗膀胱癌合并持续血尿疗效观察

目的：探讨髂内动脉化疗栓塞术治疗膀胱癌合并持续血尿的疗效。方法：经健侧股动脉穿刺插管至患侧髂内动脉灌注化疗并超选择至前支的脏支靶血管处作碘油及明胶海绵栓塞,同时作健侧髂内动脉灌注化疗和适量栓塞。结果：30例的持续血尿均得到有效控制,其中1例再次手术切除,结论：髂内动脉化疗栓塞治疗膀胱癌合并持续血尿能得到良好的疗效。     

选择性膀胱动脉栓塞与髂内动脉栓塞治疗重度出血性膀胱炎的效果比较

目的 比较膀胱动脉栓塞与髂内动脉栓塞治疗骨髓移植术后重度出血性膀胱炎(HC)的疗效.方法 收集自2008年3月至2015年5月期间共34例重度HC患者,根据病情采用选择性膀胱动脉栓塞或髂内动脉栓塞控制出血,均采用明胶海绵颗粒栓塞供血动脉.结果 ①34例患者共采用37次栓塞治疗,双侧髂内动脉栓塞14例(A组),血尿消失10例,术后于3～14 d(平均5d)止血;血尿明显减少1例,手术满意率71％;双侧膀胱动脉栓塞20例(B组),血尿消失16例,术后于2～15 d(平均4d)血尿消失.3例术后血尿减少,满意率80％.②A组术后疼痛程度2～8分(平均5分),B组术后疼痛程度0～5分(平均3分).栓塞后综合征(尿频、尿急、发热、腹痛等)持续时间:A组3～10 d(平均4.5 d),B组为2～10 d(平均3.5 d).结论 ①膀胱动脉栓塞和骼内动脉栓塞两者栓塞效果无明显差异.②选择性膀胱动脉栓塞后反应更轻,持续时间更短,应首选膀胱动脉栓塞术.     

经动脉栓塞治疗肾动静脉畸形或瘘所致血尿

目的评价经动脉栓塞治疗肾动静畸形(或瘘)所致血尿的安全性和疗效。方法回顾性分析因肉眼血尿行肾动脉造影而确诊的肾血管病变7例,包括先天性肾动静脉畸形3例,非肿瘤获得性动静脉瘘4例,选择相应的栓塞剂行动脉栓塞治疗。结果7例均获成功栓塞,术后1～7d临床肉眼血尿症状完全消失,无严重并发症,随访l2～36个月无再发。结论经动脉栓塞治疗肾动静脉畸形或瘘所致的血尿安全、有效。     

超选择性动脉栓塞术治疗医源性肾出血的临床疗效

目的评价超选择性动脉栓塞术治疗医源性肾出血的临床效果。方法 22例医源性严重血尿患者,均经选择性肾动脉数字减影血管造影(DSA)及超选择性肾动脉栓塞(TAE),其中17例用弹簧圈加明胶海绵栓塞,另5例单用明胶海绵栓塞。结果 DSA清晰地显示了全部患者病侧肾的对比剂外溢,其中4例合并动静脉瘘,主要累及肾中下极动脉分支。22例中的20例(90.9%)是一次TAE获得成功,其余2例起先均是单用明胶海绵栓塞,栓塞后,1例持续有血尿,另1例3 d后再次出现血尿,随后,二次用弹簧圈加明胶海绵栓塞遂使血尿完全消失。平均随访6个月,所有患者均无血尿复发。结论超选择性TAE对于保守治疗无效的医源性肾出血提供了一种安全且有效的治疗方法。     

创伤性肾破裂出血的动脉栓塞治疗

目的 研究创伤性肾破裂出血在保守治疗无效情况下进行动脉栓塞的造影表现及栓塞方法。方法 本组５例均为男性,年龄１２～２９岁,病人均有明确外伤史。主要临床症状：剧烈腹痛,血尿或咖啡色尿,心率加快,血压下降,其中３例出现失血性休克。５例病人在栓塞前都进行了肾动脉造影证实诊断。栓塞材料以自身凝血块为主,加用明胶海绵。结果 ５例病人经栓塞后,临床症状很快得到缓解。血压均在１２h内恢复正常水平;血尿和腹痛均在     

经皮肾镜取石术后肉眼血尿的超选择性动脉栓塞治疗

目的 探讨经皮肾镜取石术(PCNL)后无痛性肉眼血尿的原因及经导管超选择性插管肾动脉栓塞治疗(KAE)的方法和疗效.方法 共7例PCNL后持续性全程无痛性肉眼血尿患者,男5例,女2例,年龄38 ～ 64岁,平均52岁.PCNL后3～5天,左肾2例,右肾5例,7例患者均有持续性全程无痛性肉眼血尿,血压难以维持.治疗方法:采用Seldinger穿刺技术进行股动脉穿刺插管,做选择性患侧肾动脉造影,检出出血原因后超选择性插入供血动脉,用医用明胶海绵颗粒或弹簧钢丝圈栓塞靶血管,栓塞后立即造影复查.结果 7例患者均发现有肾动脉分支假性动脉瘤(RAP),其中2例合并动静脉瘘(AVF);7例患者经栓塞治疗后出血停止,血压恢复正常.栓塞前后肾功能无显著变化.结论 DSA检查是确诊PCNL后全程无痛性肉眼血尿原因的较好办法,PCNL后全程无痛性肉眼血尿的直接原因主要是肾动脉分支RAP和AVF,KAE是治疗PCNL后RAP及AVF的安全性高、疗效肯定的治疗方法.     

动脉灌注化疗联合高能超声聚焦刀治疗晚期膀胱癌8例报告

目的 :探索动脉灌注化疗联合高能超声聚焦刀 (HIFU)治疗晚期 (T3 或T4)膀胱癌的价值。方法 :用吡喃阿霉素 30～ 5 0mg/m2 进行动脉灌注化疗 1～ 2次 ,治疗结束后 1周 ,使用HIFU治疗仪FEP -BY0 1对晚期膀胱肿瘤进行治疗。结果 :经动脉灌注化疗 1～ 2次 ,8例血尿均较前有所减轻 ,其中 1例完全停止 ;联合HIFU治疗后 ,其中 5例血尿完全停止 ,2例完全缓解 ,5例部份缓解 ,有效率达 87 5 % ;且无皮肤烧伤、穿孔、大出血、疼痛等并发证出现。结论 :动脉灌注化疗联合HIFU这一新型局部治疗技术对治疗晚期膀胱癌安全有效。     

前胡桃夹综合征CT表现一例

患者男,17岁,因"肉眼无痛血尿1月余"收治入院。患者1个月前无明显诱因出现淡红色血尿,无尿频、尿急、尿痛,尿中无血块,双肾区扣痛(-),中下腹CT示:盆底静脉曲张,腹膜后及双侧腹股沟小淋巴结。膀胱镜检查显示左侧输尿管开口见喷血性尿液。B超显示左肾静脉压迫征,肾脏未见明显异常。患者为进一步治疗,门诊拟"血尿待查",收治入院。病程中无发热,小便可见淡红色肉眼血尿,无尿频、尿急等不适     

Value of "additional arterial embolization" to bilateral internal iliac TAE in patients with severe pelvic fractures

Transcatheter arterial embolization (TAE) of the bilateral internal iliac arteries has been shown to be of great value in controlling retroperitoneal massive hemorrhage associated with pelvic fractures. It has recently been reported, however, that TAE of only the bilateral internal iliac arteries sometimes fails to stabilize the patient's hemodynamics. The purpose of the present study was to evaluate "additional arterial embolization" to the bilateral internal iliac TAE in hemodynamically unstable cases. Sixty-eight patients who underwent emergency TAE following severe pelvic fractures were reviewed. Additional arterial embolization of the lumbar arteries in four patients, middle sacral arteries in two and inferior epigastric artery in one was carried out following bilateral internal iliac TAE. The damage to these arteries was associated with fractures of the lumbar costal process, sacrum, pubis, etc. The patients were in stable condition after the procedure, and no significant complication was experienced. When fractures and dislocations of the above-mentioned bones are seen on plain X-ray films and arterial bleeding is identified by angiography, additional embolization of the arteries should be performed immediately.     

先天性肾动静脉畸形的栓塞治疗

目的评价经导管动脉栓塞治疗先天性肾动静脉畸形的价值。方法回顾性分析7例以肉眼血尿为主要症状的先天性肾动静脉畸形,选择性肾动脉造影确诊为肾动静脉畸形后,超选择性病变动脉插管,用明胶海绵、无水乙醇、弹簧钢圈等对病变血管进行栓塞治疗。结果所有7例先天性肾动静脉畸形都成功栓塞,栓塞24h内7例肉眼血尿消失,术后1周内可有栓塞侧腰部酸痛、低热、腹胀、恶心、呕吐等症状,但无严重并发症。随访36～98个月无血尿复发,肾功能正常。结论经导管肾动脉造影能明确诊断,动脉栓塞安全有效,对先天性肾动静脉畸形的治疗有重要意义。     

Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration

Purpose

We evaluated the management of transcatheter arterial embolization for postpartum hemorrhage caused by vaginal laceration.

Materials and Methods

We reviewed seven cases of patients (mean age 30.9 years; range 27–35) with intractable hemorrhages and pelvic hematomas caused by vaginal lacerations, who underwent superselective transcatheter arterial embolization from January 2008 to July 2014. Postpartum hemorrhage was evaluated by angiographic vascular mapping to determine the vaginal artery’s architecture, technical and clinical success rates, and complications.

Results

The vaginal artery was confirmed as the source of bleeding in all cases. The artery was found to originate from the uterine artery in three cases, the uterine and obturator arteries in two, or the internal pudendal artery in two. After vaginal artery embolization, persistent contrast extravasation from the inferior mesenteric artery as an anastomotic branch was noted in one patient. Nontarget vessels (the inferior vesical artery and nonbleeding vaginal arterial branches) were embolized in one patient. Effective control of hemostasis and no post-procedural complications were confirmed for all cases.

Conclusion

Postpartum hemorrhages caused by vaginal lacerations involve the vaginal artery arising from the anterior trunk of the internal iliac artery with various branching patterns. Superselective vaginal artery embolization is clinically acceptable for the successful treatment of vaginal laceration hemorrhages, with no complications. After vaginal artery embolization, it is suggested to check for the presence of other possible bleeding vessels by pelvic aortography with a catheter tip at the L3 vertebral level, and to perform a follow-up assessment.

     

髂内动脉输注和栓塞对盆腔肿瘤诊治的价值

目的:通过分析髂内动脉造影和栓塞治疗效果,结合CT、腔镜及术后病检结果,初步评估髂内动脉输注和栓塞治疗盆腔肿瘤的价值。方法:12例盆腔肿瘤患者,行双侧髂内动脉造影、输注后,作单侧或双侧供血血管的超选择插管栓塞,重点观察其血管造影表现和栓后临床症状的改善情况、CT扫描变化及术后病理检查结果,评估其疗效。结果:9例富血管肿瘤(6例膀胱癌、2例宫颈癌及1例子宫内膜癌)显示有典型的血管增多、增粗、不规则且有显著的肿瘤染色而得以诊断,而后行栓塞治疗,6例栓后手术病理发现瘤体不同程度的坏死,3例未行手术的患者,B超、CT发现瘤体明显缩小,血尿或阴道出血停止并维持达二月。3例少血管肿瘤(膀胱癌),没有明显的血供异常,仅行化疗并在1周内手术。结论:髂内动脉化疗输注和栓塞对盆腔肿瘤有较好的治疗价值。     

Peripheral vascular applications of the Amplatzer vascular plug

PURPOSE: To present our experience using the Amplatzer vascular plug in various arterial and venous systems, and follow-up results. MATERIALS AND METHODS: Between May 2005 and October 2006, 20 Amplatzer vascular plugs were used to achieve occlusion in 20 vessels in 12 patients (10 male, 2 female) aged between 24 and 80 years (mean age, 55 years). Localization and indications for embolotherapy were as follows: pulmonary arteriovenous malformations (n = 3; 9 vessels), internal iliac artery embolization before stent-graft repair for aortoiliac aneurysms (n = 4; 4 vessels), preoperative (right hemipelvectomy) embolization of bilateral internal iliac arteries (n = 1), bilateral internal iliac aneurysms (n = 1), large thoracic side branch of the left internal mammary artery coronary by-pass graft causing coronary steal syndrome (n = 1), closure of a transjugular intrahepatic portosystemic shunt (n = 1), and testicular vein embolization for a varicocele (n = 1). RESULTS: The technical success rate was 100%, with total occlusion of all the targeted vessels. Only one device was used to achieve total occlusion of the targeted vessel in all patients (device size range, 6-16 mm in diameter). No major complications occurred. Target vessel occlusion time after deployment of the Amplatzer vascular plug was 6-10 min in pulmonary arteries (mean, 7.5 min) and 10-35 min (mean, 24.4 min) in systemic arteries. Mean follow-up was 6.7 months (range, 1-18 months). CONCLUSION: Embolization with the Amplatzer vascular plug is safe, feasible, and technically simple with appropriate patient selection in various vascular territories.     

急诊行髂内动脉栓塞治疗16例骨盆骨折并大出血

目的探讨髂内动脉栓塞治疗骨盆骨折并大出血的临床效果。方法对16例骨盆骨折并大出血患者,经保守治疗无效,急诊行单侧或双侧髂内动脉造影,明确出血部位后,经导管用明胶海绵或弹簧圈栓塞。结果 16例骨盆骨折并大出血患者经髂内动脉栓塞后活动性出血停止,除1例死于术后70h外,绝大多数患者的出血性休克得到明显控制。结论髂内动脉栓塞是治疗骨盆骨折并大出血的一个快速、合理、有效的方法。     

Transcatheter treatment of life-threatening lower gastrointestinal bleeding due to advanced pelvic malignancy

We present two patients with life-threatening, massive, lower gastrointestinal (GI) bleeding and locally advanced cervical carcinoma. Selective pelvic arteriography demonstrated that the site of bleeding originated from a pseudoaneurysm of the right internal iliac artery with fistulous communication to the sigmoid colon in one patient and from the left internal iliac artery into the rectum in the second patient. Transcatheter embolotherapy was then performed using balloon occlusion in one patient and coil embolization in the second patient. The iliac arteries should also be evaluated in patients with pelvic cancer who present with lower GI bleeding.     

Endovascular Treatment of Concurrent Bilateral Common and Internal Iliac Artery Aneurysms with Preserved Pelvic Circulation: Bilateral Iliac Branch Devices with Opposing Single Division Internal Iliac Artery Sparing

An 83-year-old man with bilateral common iliac artery aneurysms (right, 3.0 cm; left, 2.7 cm), bilateral internal iliac artery aneurysms (right, 3.4 cm; left, 2.6 cm), and an abdominal aortic aneurysm (3.8 cm) was treated with an aortobi-iliac stent graft and bilateral iliac branch devices. The internal iliac components were extended into opposing posterior (left) and anterior (right) divisions of the internal iliac artery using stent grafts. Computed tomography angiography demonstrated that all aneurysms decreased or were stable in size with patent stent grafts at 1 month. The patient was asymptomatic without complications of pelvic ischemia at the last clinical follow-up at 6 months.