子宫动脉假性动脉瘤经导管栓塞治疗2例

子宫动脉假性动脉瘤(uterine artery pseudoaneurysm,UAP)是罕见的但危及生命的并发症[1].现报道2例经导管成功栓塞治疗UAP,并作简要讨论.临床资料例1:患者61岁,因“阴道流血15 d,腹痛1d”收入院,33年前曾因“宫外孕”行“右侧输卵管切除术”,绝经年龄55岁.子宫腔内超声提示:“子宫内混合性肿块(大小约130 mm×115 mm×110 mm),考虑肌瘤变性,不除外肿瘤”.盆腔MRI提示:“子宫体积增大,内见一团块状不规则混杂信号影,直径约13.1 cm,T1WI、T2WI呈混杂信号,边界欠清楚,结合带不完整,增强后病灶实性部分明显强化,考虑子宫恶性肉瘤”.     

经导管动脉栓塞治疗8例脾动脉瘤

目的 探讨经导管动脉栓塞治疗脾动脉瘤的可行性和疗效.方法 对8例脾动脉瘤患者,经导管通过脾动脉使用弹簧圈栓塞瘤体远近端动脉而将瘤体隔绝,术后采用CT或血管彩色多普勒超声随访3～36个月.结果 8例脾动脉瘤均成功栓塞,无严重并发症.1例术后10个月因腹腔大出血死亡,其余7例随访3～36个月情况良好,未见血管再通.结论 经导管动脉栓塞治疗脾动脉瘤安全可行,术后定期影像随访非常重要.     

经导管血管内栓塞治疗肝动脉假性动脉瘤的疗效观察

目的 评价血管内栓塞治疗肝动脉假性动脉瘤(HAPA)的疗效和对肝功能的影响.资料与方法 8例HAPA患者行选择性腹腔动脉造影明确动脉瘤的部位后,再超选择至载瘤动脉进行血管内栓塞治疗.栓塞术后随访3～60个月,观察临床和肝功能情况.结果 8例血管造影均明确诊断.其中肝外型4例,肝内型4例;7例用弹簧圈或微弹簧圈栓塞,1例单纯明胶海绵颗粒栓塞.栓塞术后造影复查8例HAPA均消失.动脉瘤破裂出血患者出血均停止.阻塞性黄疸的患者术后1周黄疸消褪.1例单纯明胶海绵颗粒栓塞者术后3天出血复发;7例钢圈栓塞者无出血和HAPA复发,影像学复查4例HAPA消失,3例HAPA缩小、机化.肝功能检查,2例转氨酶一过性轻度升高[谷-草转氨酶(AST)达286 U/L,谷-丙转氨酶(ALT)达103 U/L)],2例栓塞前肝功能异常栓塞后1周恢复正常;余4例肝功能无异常改变.结论 弹簧圈血管内栓塞治疗HAPA疗效好、并发症少.选择性肝动脉弹簧圈栓塞,对肝功能无明显影响.     

巨大假性动脉瘤的留置导管分次栓塞治疗一例

我们采用动脉插管及导管留置技术用无水乙醇、明胶海绵、不锈钢圈对一例巨大假性动脉瘤进行分次栓塞治疗,取得满意效果,现将治疗体会报告如下。患者,女,45岁,因腹部搏动性肿物一年余入院。该患者三年前曾患右髂内动脉瘤,并行动脉瘤切除术。一年前不明原因出现阵发性腹痛,继之在脐部右侧触及一搏动性肿物,一年来症状日趋加重。查体:于脐部右侧可触及一鸭蛋大小的搏动性肿物,听诊可闻及收缩期吹风样杂音。彩超示:腹主动脉下段分又处见一约6×8cm的无回声区,有动脉血流声。临床诊断为右髂内动脉复发性假性动脉瘤。采用 Seldinger 技术行右股动脉穿刺     

栓塞治疗腹腔干假性动脉瘤一例

患者男，38岁。无明显诱因反复出现右下腹疼痛1个月入院。体检：双侧足背动脉搏动较弱。     

经导管栓塞左椎动脉巨大假性动脉瘤一例

患者 男,28岁。颈项部被刀破伤30min,流血不止,急诊入院。体检：Bp80/40mmHg,P135次/min。颈项左侧由枕骨隆突下3cm斜行至右耳屏伤口长约15cm,急行局部清创,缝轧颈外侧动脉止血,离断肌肉吻合顺利。术后1～3d伤口无异常,亦无红肿及疼痛。     

急性胰腺炎出血的血管造影诊断及经导管栓塞治疗

目的探讨急性胰腺炎出血的血管造影诊断及经导管栓塞治疗的方法选择及疗效。方法回顾性分析19例急性胰腺炎并发腹腔或胃肠道出血患者行血管介入诊疗的临床资料及治疗结果。结果19例患者共行血管造影检查23次,发现胰及胰周血管破裂出血者9例次(9/23,39.1%),假性动脉瘤破裂出血者10例次(10/23,43.5%),脾静脉血栓形成1例次(1/23,4.3%),不能明确出血部位者4例次(4/23,17.4%)。其中13例患者行经导管栓塞治疗。随访1～7个月,5例再发出血,其中4例再次血管造影均发现新的出血病灶,3例患者再次行栓塞治疗,其中2例患者最终因合并严重感染和多器官功能衰竭而死亡,另1例患者经过2次栓塞后无再出血。结论血管造影诊断和经动脉栓塞治疗是急性胰腺炎并出血时首选的紧急治疗方法。     

经动脉栓塞治疗右肾上极假性动脉瘤一例

肾脏假性动脉瘤较为少见 ,中山医院介入科最近收治 1例 ,报告如下。患者 ,男 ,19岁 ,右肾刀刺伤近半年入院。半年前 ,患者两侧腰背部刺伤 ,右侧较深 ,ＣＴ检查示 :右肾周血肿 ,后行“右肾周血肿清除术” ,术后恢复可。查体 :两侧腰背部见刀刺伤和手术切口瘢痕 ,余无特殊。ＭＲＩ检查 :ＭＲＡ重建图象示右肾上极见一肾动脉同时强化的高信号团影 ,其下基底部可见与一肾叶间动脉相连 (图 1)。横断位Ｔ1ＷＩ该肿块表现为血管流空 (图 2 )。Ｔ2 ＷＩ其中可见慢血流不均匀高信号影 ,病灶直径约 2 .2ｃｍ× 3 .2ｃｍ大小。　　ＤＳＡ检查 :右肾动脉…     

脾动脉栓塞治疗胰源性假性脾动脉瘤

目的探讨动脉栓塞术治疗急、慢性胰腺炎合并假性脾动脉瘤的临床可行性，并观察其临床效果。方法8例假性脾动脉瘤病人，6例为急性胰腺炎坏死组织清除术后腹腔和胃肠道出血；2例为慢性胰腺炎，其中1例消化道出血，1例无症状偶然发现瘤体者。运用弹簧钢圈栓塞脾动脉破口的近、远两端。术后CT观察瘤体灌注情况及出血情况。结果8例病人均栓塞成功，7例出血者成功止血，无症状者CT复查瘤体无对比剂灌注；随访3—21个月，6例无再发出血。结论经皮穿刺脾动脉栓塞术是1种简便、安全、有效的治疗假性脾动脉瘤方法。     

Multiple small pseudoaneurysms complicating pancreatitis: angiographic diagnosis and transcatheter embolization

We report a case of retroperitoneal hemorrhage due to multiple, small pseudoaneurysms complicating a chronic alcoholic pancreatitis. Cross-sectional imaging with CT and US could not clearly depict these vascular lesions. Selective arteriography of the superior mesenteric and gastroduodenal arteries clearly showed the small pseudoaneurysms and definitive treatment was performed by transcatheter embolization using coils. Eight months after successful embolization, the patient is asymptomatic without any recurrent bleeding. Received: 18 June 1999; Revised: 13 October 1999; Accepted: 15 October 1999     

Transcatheter management of pseudoaneurysms complicating pancreatitis.

Hemorrhage from rupture of an arterial pseudoaneurysm is a potentially fatal complication of pancreatitis. Seventeen patients underwent transcatheter embolization of 23 arteries for the treatment of 20 arterial pseudoaneurysms secondary to pancreatitis. Their records were reviewed retrospectively to evaluate the clinical benefit of transcatheter therapy. At presentation, 15 of the 17 patients had gastrointestinal, intrasplenic, retroperitoneal, intraperitoneal, or postoperative wound bleeding. Transcatheter embolotherapy was the sole treatment for 16 (80%) of the 20 pseudoaneurysms in 13 patients. Four pseudoaneurysms (20%) in four patients were treated prior to splenectomy. Transcatheter therapy was clinically beneficial in all patients. Three patients had procedural complications without significant clinical sequelae. Transcatheter embolotherapy should be the initial treatment of choice in patients with arterial pseudoaneurysms secondary to pancreatitis. Treatment may be definitive or facilitate subsequent surgery.     

颈内动脉病变性顽固鼻腔大出血的急症栓塞治疗

目的 探讨颈内动脉闭塞术治疗外伤性颈内动脉虹吸段病变导致的顽固鼻腔大出血的临床效果.方法 回顾性分析栓塞治疗的37例外伤性颈内动脉虹吸段假性动脉瘤或颈内动脉海绵窦瘘导致的顽固性鼻腔大出血患者的临床资料.37例中男34例,女3例;年龄25～65岁,平均40岁.12例栓塞病变而保持颈内动脉通畅,25例行患侧颈内动脉闭塞术.结果 36例患者术后未发生鼻腔再出血,痊愈出院.1例颈内动脉栓塞患者,因Willis环侧支循环代偿不良发生大面积脑梗死,于术后48 h死亡.结论 Willis环侧支循环代偿良好的颈内动脉性顽固鼻腔大出血,仅消除病变不能达到理想效果时,栓塞患侧颈内动脉,可以快捷简便的挽救患者生命.     

可膨胀水凝胶弹簧圈在颅内动脉瘤急性破裂期栓塞中的应用

目的 探讨可膨胀水凝胶弹簧圈( Hydrocoil)在颅内动脉瘤急性破裂期栓塞中的应用价值.方法 应用Hydrocoil栓塞急性破裂期15例17个颅内动脉瘤,并选择同期应用裸性铂金弹簧圈栓塞的18例颅内动脉瘤进行对比分析.结果经x2检验.结果 Hydrocoil栓塞的17个动脉瘤,致密栓塞16个、大部栓塞1个.裸性铂金弹簧圈栓塞的18例动脉瘤,致密栓塞11例、大部栓塞7例.两者疗效差异有统计学意义(x2=5.402,P＜0.05).患者术后6个月至1.5年内DSA检查,应用Hydrocoil栓塞的患者无复发;应用裸性铂金弹簧圈栓塞的患者动脉瘤复发5例.两者复发率差异有统计学意义(x2 =5.510,P＜0.05).结论 Hydrocoil可提高颅内动脉瘤的致密栓塞程度,并降低颅内动脉瘤栓塞术后的复发率.     

经导管凝血酶栓塞治疗十二指肠巨大假性动脉瘤一例

患者男,75岁。无意间扪及上腹部包块伴压痛,经CT检查发现为腹腔占位(图1),疑为动脉瘤。为确定诊断,于2005年6月23日在局麻下经右股动脉穿刺插管,行腹腔动脉造影见十二指肠动脉巨大假性动脉瘤(图2),约4.6 cm×5.8 cm。有介入栓塞治疗指征。造影后即用导丝将导管导引至十二指肠动脉破口远端,用3 mm×3 cm金属弹簧圈2枚进行栓塞,阻止远端血流逆行入动脉瘤内,在栓塞假性动脉瘤近端十二指肠动脉时,用了2枚8 mm×5 cm金属弹簧圈栓塞,但因残     

Transcatheter embolization therapy of pseudoaneurysms in patients with chronic pancreatitis

Chronic pancreatitis is known to cause vascular disorders including pseudoaneurysm of peripancreatic arteries. Although the incidence of pseudoaneurysms due to pancreatitis detected by angiography has been reported as high as 10% in western literature, they are still considered rare in Japan. We reported two cases of pseudoaneurysm caused by chronic pancreatitis, one in splenic artery and the other in gastroduodenal artery, successfully treated by embolization. The embolizations were performed by occluding proximal splenic artery for splenic arterial aneurysm and gastroduodenal artery distal and proximal to the orifice for the aneurysm of gastroduodenal artery with stainless steel coils. Since the surgical therapy has high mortality rate, we consider transcatheter embolization is the treatment of choice for pseudoaneurysms caused by chronic pancreatitis.     

先天性肾动静脉畸形的栓塞治疗

目的评价经导管动脉栓塞治疗先天性肾动静脉畸形的价值。方法回顾性分析7例以肉眼血尿为主要症状的先天性肾动静脉畸形,选择性肾动脉造影确诊为肾动静脉畸形后,超选择性病变动脉插管,用明胶海绵、无水乙醇、弹簧钢圈等对病变血管进行栓塞治疗。结果所有7例先天性肾动静脉畸形都成功栓塞,栓塞24h内7例肉眼血尿消失,术后1周内可有栓塞侧腰部酸痛、低热、腹胀、恶心、呕吐等症状,但无严重并发症。随访36～98个月无血尿复发,肾功能正常。结论经导管肾动脉造影能明确诊断,动脉栓塞安全有效,对先天性肾动静脉畸形的治疗有重要意义。