血管内介入技术在腹部手术后近期再出血诊治中的临床应用

目的探讨血管内介入技术在腹部手术后近期再出血诊治中的临床应用价值。方法山西省人民医院2010年12月至2012年12月腹部手术后近期再出血病例10例，均在输血、补液、纠正休克的同时，采用Selding’s技术行血管造影术，确定出血动脉，并立即行出血动脉栓塞术。结果10例患者均通过血管造影发现出血动脉，并进行了栓塞术。共行血管造影11次，栓塞治疗10次，共用弹簧圈（直径2—8mrla）48枚。聚乙烯醇颗粒3g.10例患者当时均获得良好的止血效果。9例随访30d均未复发；1例胰十二指肠切除术后1周，胃十二指肠动脉残端出血，行胃十二指肠动脉残端及肝总动脉不锈钢圈栓塞术后，血压上升维持正常水平，但心率持续较快，维持在130-140次／min，可疑仍有活动性出血，24h后再次行腹部血管造影未发现异常，家属放弃治疗。结论血管内介入技术是一种安全、有效、实用的对腹部手术后近期再出血诊治手段。

Clinical application of endovascular interventional technology treating recent re-bleeding eases after abdomi-nal surgery

Objective To discuss clinical application value of endovascular interventional technology trea- ting recent re-bleeding cases after abdominal surgery. Methods Ten cases with recent re-bleeding after abdominal surgery were summarized. All of them underwent blood transfusion, rehydration, correcting shock and angiography to find out the bleeding artery. Results All the ten patients who had bleeding after angiography were embolized later. Angiographic,embolization, 48 coil （diameter 2-8 mm）and 3 grams polyvinyl alcohol particles were used. The ten patients stopped bleeding after embolism. 9 cases during follow-up 30 days did not have bleeding again. 1 case had liver iliac artery stainless steel ring embolization. After embolism the blood pressure was normal, but the heart rate was fast （between 130-140 times/min） and was suspected of active bleeding. 24 hours later, the patient underwent the second angiography but nothing was found. Conclusion Clinical application of endovascular interventional technology treating recent re-bleeding eases after abdominal surgery is accurate, safe and simule.