胆道出血的介入诊断与治疗(附3例报告)

目的　探讨介入在诊断与治疗胆道大出血中的应用价值。　方法　对 2例肝外伤手术后及 1例胆道结石手术后多次胆道大出血病人采用Seldinger技术行肠系膜上动脉及肝动脉插管DSA检查 ,显示胆道出血血管的部位、出血分布、假性动脉瘤及动静脉瘘形成情况 ,然后用微导管插管至出血血管分支 ,应用NBCA、PVA颗粒、明胶海绵及弹簧钢圈选择性栓塞。　结果　 2例为弥漫性出血 ,1例为局限性出血 ,2例有假性动脉瘤形成 ,1例有肝动脉 -门静脉瘘形成。栓塞后造影显示出血血管成功栓塞 ,出血症状迅速停止。　结论　介入是胆道大出血诊断与治疗的有效措施。

Interventional diagnosis and management of patients with hemobilia (A report of 3 cases)

Objective To evaluate the value of vascular intervention in the diagnosis and management of hemobilia. Methods With Seldinger's technique ,digital subtraction angiography of superior mesenteric artery and hepatic arteriography were performed on 3 patients with hemobilia, two of whom manifested hemobilia after the operation of liver trauma and one of whom did after the operation of command bile duct stones . Arteriography showed the bleeding vascular branch, the false aneurysm and the arteriovenous fistula. And then a small catheter was put into the bleeding focus. The bleeding branch arteries were selectively embolized with embolus of n-butyl cyanoacrylate (NBCA),PVA granule,spring wire loop and gelatin sponge. Results Two cases showed diffuse bleeding focus and another showed a local bleeding focus. Two cases had expression of false aneurysm and one showed expression of ateriovenous fistula. The artery branches of the bleeding focus were successfully embolizated and the hemobilia stopped immediately. Conclusions Vascular intervention is an effective method for the diagnosis and management of hemobilia.