急诊髂内动脉栓塞治疗骨盆骨折大出血

目的:探讨急诊髂内动脉栓塞治疗骨盆骨折大出血的临床价值。方法:对12例骨盆骨折合并失血性休克的患者行紧急髂内动脉造影,对出血动脉用明胶海绵进行栓塞;伴有肝脾破裂者同时行肝脾动脉栓塞。结果:髂内动脉造影显示对比剂血管外溢11例,伴髂内动脉主要分支断流2例,1例仅表现为髂内动脉分支广泛痉挛伴脾下极动脉出血;栓塞后出血均停止,全部患者24h内血压回升至正常水平,术后未发生严重的并发症。除1例合并多脏器功能衰竭(MODS)死亡外,其余都得到有效救治。结论:急诊髂内动脉栓塞是院内急救骨盆骨折大出血的首选方法,具有迅速、安全的优点。

Emergency Hypogastric artery Embolization in the Treatment of Massive Hemorrhage Caused by Pelvic Fracture

Objective:To investigate the clinical significance of emergency hypogastric artery embolization for the treatment of massive hemorrhage caused by pelvic fracture.Methods:Emergency arteriography and embolization with gelatin sponge using Seldinger technique was performed in 12 patients with uncontrolled massive hemorrhage complicated with shock.Hepatic and/or splenic artery embolization were given with accompanied liver and/or spleen rupture.Results:Of these 12 patients,11 cases had contrast medium extravasation demonstrated by hypogastric arteriography;2 cases had main branches of hypogastric artery interruption,1 case showed diffuse spasm of branches of hypogastric artery and bleeding of inferior splenic artery.Cease of bleeding was showed after embolization.All patients had blood pressure regained to normal standard within 24 hours.No serious complication was observed.Apart from 1 patient died of multiple-organ dysfunction syndrome (MODS),the rest of the patients were successfully salvaged by arterial embolization.Conclusion:Emergency hypogastric artery embolization is the first choice of approach for controlling massive hemorrhage with pelvic fracture.The advantages arise from promptness,easy-operating and safety.