选择性血管造影及栓塞治疗胆系术后大出血

目的评价选择性血管造影及栓塞治疗胆系术后大出血的有效性。方法回顾性分析9例胆道术后大出血患者的临床资料。9例患者急诊行腹腔动脉、选择性肝动脉及肠系膜上动脉造影，并以明胶海绵颗粒或钢圈栓塞治疗。结果血管造影显示肝动脉假性动脉瘤3例、肝动脉分支出血3例、胃十二指肠分支出血2例、空肠动脉分支出血1例。所有患者均经血管造影迅速明确诊断，并成功栓塞出血动脉8例。1例患者因出血复发行二次栓塞止血成功。经3个月-2年的随访未见出血复发及严重并发症的发生。1例患者因血管加压素灌注止血失败改行手术治疗。结论选择性血管造影及栓塞安全、可靠、创伤小，是诊断和治疗胆系术后大出血的有效方法。

Selective artery angiography and embolization in patients with massive hemobilia after biliary surgery

Objective To evaluate the effectiveness of selective artery angiography and embolization in diagnosis and treatment of severe massive hemobilia after biliary surgery. Methods The clinical data of 9 patients with massive hemobilia after biliary surgery were analyzed retrospectively. These patients underwent emergency celiac, selective hepatic and superior mesenteric artery angiography and treated by embolization using Gelfoam particles and/or coils. Results Selective artery angiography revealed hepatic artery pseudoaneurysms in 3 patients, 3 cases hemorrhage of hepatic artery branches,2 cases gastroduodenal artery branches in 2, and jejunal artery branches 1 eaes. The patients were diagnosed rapidly by angiography and treated successfully by embolization of the bleeding artery in 8, and hemorrhage was stopped immediately. One patients was embolized the second time for rebleeding. Neither recurrence of bleeding nor serious complication was found during the follow-up for 3 months to 2 years. The other one patient whose hemorrhage failed to be controlled by vasopressin and underwent surgery. Conclusion Being safe, reliable and minimally invasive, selective artery angiography and embolization are effective in the diagnosis and treatment of massive hemobilia after biliary surgery.