急诊介入行明胶海绵动脉栓塞术治疗外伤性大出血

目的评价急诊介入行明胶海绵动脉栓塞术治疗外伤性大出血的疗效。方法31例外伤性大出血均采用急诊动脉造影明确出血血管,其中3例肝脏损伤,肝左动脉损伤1例,肝右动脉损伤伴假性动脉瘤形成2例 13例肾脏挫裂伤,左肾挫裂伤6例,右肾挫裂伤7例,造影示：肾动脉前支出血4例,后支出血3例,前后支均有出血2例,肾段动脉出血2例 15例骨盆骨折,9例一侧髂内动脉损伤,6例双侧髂内动脉损伤,3例假性动脉瘤形成,10例分支动脉干中断,8例臀上动脉呈抱球状 出血动脉有：阴部内动脉、闭孔动脉、臀上动脉,2支以上分支动脉出血4例。全部选择或超选择插管用明胶海绵颗粒及海绵条行栓塞治疗。结果明胶海绵颗粒及海绵条栓塞治疗后即时止血效果100%,均无再出血,全部患者6h内血压回升至正常。13例肾脏损伤患者,栓塞术后1-3d血尿消失,1个月后复查IVU或CT增强显示所有患侧肾脏仍有部分功能。26例不同程度出现栓塞后综合症,经对症处理后消退,无严重并发症 所有患者1个月后复查肝肾功能正常。结论急诊介入行明胶海绵动脉栓塞是治疗外伤性大出血的安全有效的方法。

Emergency Intra- arterial Embolism with Gelfoam in Treatment of Traumatic Hemorrhea

Objective To evaluate the effect of emergency intra - arterial embolism with Gelfoam in treatment of traumatic hemorrhea. Methods Emergency intra - arterial embolism was performed in all traumatic hemorrhea cases in this group （ n = 31 ）. Injury in left hepatic artery （ n = 1 ） or right hepatic artery combined with pseudoaneurysm （ n = 2 ） were involved with hepatic injury （ n = 3 ）. Contusion of kidney （ n = 13 ） was due to renal artery bleeding which involved with segmental renal artery （ n = 2 ）, ramus anterior arteriae renalis （ n = 4）, ramus posterior arteriae renalis （n = 3 ） or both of anterior and posterior ramus （ n = 2）. Lesion in unilateral internal iliac artery （ n = 9） or bilateral internal iliac artery （n = 6） were detected in 15 pelvic fracture cases, the bleeding branch included internal pudendal artery, obturator artery and superior gluteal artery, more than 2 branches bleeding was defined in 4 patients. Particle and strip of gelfoam was used in selective or ultraselective embolism. Results Initial success rate of embolism was 100% with no rebleeding, blood pressure returned to normal within 6 hours in all patients. Hematuria disappeared within 1 -3 days after embolism in all renal injury cases （ n = 13 ） , and 1 month follow - up IVU or CT contrast enhanced scan showed that renal function was partially reserved. Post embolism syndrome was observed in 26 patients and was relieved after symptomatic treatment, there was no other serious complication occurred, hepatic function and renal function returned to normal after 1 month. Conclusion Emergency intra - arterial embolism with Gelfoam is ideal safe and effective in treatment of traumatic hemorrhea.