肝脏创伤性假性动脉瘤和动静脉瘘的诊治

目的 探讨肝脏创伤性假性动脉瘤(post-traumatic intrahepatic pseudoaneurysm，HPA)及动静瘘瘦(arteriovenous fistula,AVF)的临床特点及诊疗手段。方法 肝创伤性HPA／AVF病人13例，对其临床资料进行回顾性总结。结果 其主要病因为严重肝破裂伤和深部肝穿刺伤(10例)，病变部位肝右叶(8例)＞左叶(3例)＞肝门部(2例)，症状以迟发性出血伴腹痛为主(11例)，诊断率贴A＞CT＞B超。治疗包括肝动脉栓塞治疗(7例)，肝叶切除(3例)，瘤体切除、肝动脉结扎(2例)，1例未做特殊治疗。结论 创伤性HPA／AVF是肝外伤后迟发出血的重要原因，肝动脉造影及栓塞术是该类疾病的主要诊疗手段。

Diagnosis and treatment of post-traumatic intrahepatic pseudoaneurysm and arteriovenous fistula

ObjectiveTo investigate the clinical features of post-traumatic intrahepatic pseudoaneurysm (HPA) and arteriovenous fistula (AVF) and determine approaches for their diagnosis and treatment. MethodsThe clinical data of 13 patients with post-traumatic HPA/AVF treated in our hospital from January 1996 to December 2001 were retrospectively analyzed. ResultsThe main reason for HPA/AVF was blunt or penetrating liver wounds (10 cases in all). The most common site was right hepatic lobe (8 cases), then left lobe (3 cases) and porta hepatis (2 cases). Delayed hemobilia along with abdominal pain were the major symptoms (12 in all) and they were diagnosed by hepatic artery angiography (100%), abdominal CT (70%) and Doppler ultrasonography (41.6%). The treatments for HPA/AVF include hepatic artery embolization (7 cases), hepatic lobectomy (3 cases) and hepatic artery ligation after Pseudoaneurysm resection. ConclusionsHPA/AVF is one of the important causes of delayed hemobilia after liver wound and hepatic artery angiography and embolization are the main methods for diagnosis and treatment of HPA/AVF.