腹部脏器假性动脉瘤诊治体会

目的 总结腹部脏器假性动脉瘤的诊断和治疗经验。方法 回顾性分析1990～2001年16例腹部脏器假性动脉瘤,其中肝动脉瘤6例、脾动脉瘤6例、胃十二指肠动脉瘤4例。全部病例均获得随访,平均2年。结果 16例假性动脉瘤病人中15例表现为破裂出血。手术3例,成功2例,死亡1例。经动脉导管栓塞13例,全部成功且无并发症及复发。结论 数字减影血管造影术对腹部脏器假性动脉瘤急诊有确诊价值,经动脉导管栓塞术是绝大多数病人首选而有效的治疗方法。     

重症胰腺炎并发胰十二指肠下动脉瘤破裂大出血

目的　提高对重症胰腺炎合并假性动脉瘤的诊治水平。方法　报告 1例重症胰腺炎并发胰十二指肠动脉瘤出血的诊治过程并文献复习。结果　该患者经受 3次腹部手术未能止血 ,用经导管动脉栓塞出血停止。结论　经导管动脉栓塞是重症胰腺炎并发假性动脉瘤出血的首选方法     

经导管选择性动脉栓塞治疗创伤性假性动脉瘤

目的探讨经导管选择性动脉栓塞治疗损伤性假性动脉瘤的疗效。方法 16例损伤性出血患者,其中肾脏出血5例,肝脏出血3例,剖宫产后出血4例,切口妊娠流产1例,宫颈癌放疗后出血1例,骨外伤术后出血2例。采用经股动脉穿刺选择性插管进行靶动脉造影及栓塞治疗。采用明胶海绵和（或）弹簧钢圈栓塞瘤腔及供血动脉。结果全部患者动脉造影均见假性动脉瘤,其中2例伴有动静脉瘘。栓塞成功率100%,栓塞后即刻造影示假性动脉瘤消失,止血成功率93.75%。术后均未发生严重并发症,随防6个月均无复发。结论经导管选择性动脉栓塞治疗损伤性假性动脉瘤性出血安全有效、创伤小、并发症少,是可靠的治疗方法 。     

肾动脉假性动脉瘤的栓塞治疗

目的探讨经皮肾动脉造影及栓塞治疗肾动脉假性动脉瘤的临床价值。方法 2012年1月~2014年2月15例泌尿系结石术后尿道出血,经皮肾动脉造影诊断为肾动脉假性动脉瘤,导管超选择进入载瘤动脉近端,使用弹簧圈和明胶海绵栓塞载瘤动脉。结果 15例经肾动脉造影均能清晰显示假性动脉瘤,其中位于叶间动脉11例,弓状动脉3例和小叶间动脉1例,经导管弹簧圈栓塞后尿道出血停止。1例介入栓塞术后2 d再次出现尿道出血,再次栓塞后出血停止。栓塞术后2例出现一过性肾绞痛;7例体温37.8~39.3℃,持续3~8 d。15例随访3~24个月(平均15个月),无肾功能不全和尿道出血发生。结论经皮肾动脉造影和经导管栓塞治疗肾动脉假性动脉瘤安全、有效。     

重症胰腺炎并发胰十二指肠下动脉瘤破裂大出血

目的提高对重症胰腺炎合并假性动脉瘤的诊治水平。方法报告1例重症胰腺炎并发胰十二指肠动脉瘤出血的诊治过程并献复习。结果该患经受3次腹部手术未能止血，用经导管动脉栓寒出血停止。结论经导管动脉栓塞是重症胰腺炎并发假性动脉瘤出血的首选方法。     

经导管动脉栓塞术治疗重症急性胰腺炎并发假性动脉瘤破裂出血

目的探讨经导管动脉栓塞术(TAE)在重症急性胰腺炎(SAP)并发假性动脉瘤破裂出血中的应用价值。方法对13例SAP并发假性动脉瘤破裂出血患者行TAE,分析假性动脉瘤DSA表现及栓塞情况。结果 13例SAP患者共并发15个假性动脉瘤,包括感染性假性动脉瘤13个、腐蚀性假性动脉瘤2个。6个(6/15,40.00%)假性动脉瘤的责任动脉为脾动脉,5个(5/15,33.33%)为肠系膜上动脉,2个(2/15,13.33%)为胃十二指肠动脉,1个(1/15,6.67%)为肠系膜下动脉,1个(1/15,6.67%)为胃网膜右动脉(1/15,6.67%)。TAE治疗技术成功率为93.33%(14/15)。1例(1个假性动脉瘤)TAE术后出现脾脓肿,经穿刺引流及抗感染好转。感染性假性动脉瘤患者死亡率为45.45%(5/11),腐蚀性假性动脉瘤无死亡患者。TAE术后复发出血率为15.38%(2/13)。结论 TAE是治疗SAP并发假性动脉瘤破裂出血的有效方法。     

顽固性鼻出血的血管内栓塞治疗

目的探讨经导管动脉栓塞治疗顽固性鼻出血的临床价值。方法对21例经前后鼻腔填塞和（或）鼻内镜下止血后无效的鼻出血患者,经血管造影明确责任动脉后行血管内栓塞,所有病例随访30天。结果21例鼻出血患者中,20例成功实施栓塞治疗,技术成功率为95．24％（20121）,1例假性动脉瘤造影时动脉瘤破裂患者死亡;16例栓塞后活动性出血停止,4例仍有少量出血,结合内科治疗后出血渐止,栓塞有效率100％（20／20）。所有病例随访30天内均无再发出血;16例栓塞后无并发症出现,3例术后出现头痛、发热、颌面部胀痛等,1例出现右眼视野缺损。结论对于顽固性鼻出血,经导管动脉栓塞是一种安全有效的治疗方法。     

腹部手术后腹腔干分支假性动脉瘤消化道瘘的临床分析：附5例分析

目的:总结分析腹部手术后腹腔干分支假性动脉瘤消化道瘘导致的迟发性消化道大出血的诊断和治疗。方法:回顾性分析自2013年1月—2014年9月腹部肿瘤术后上消化道大出血经造影证实腹腔干分支假性动脉瘤消化道瘘的5例患者的临床资料。结果:5例患者消化道出血时间平均为术后53.6 d;假性动脉瘤位于脾动脉2例,位于肝总动脉2例,位于左肝动脉1例;造影后行栓塞治疗4例,行覆膜支架置入1例。无术后严重并发症及围手术死亡病例。随访时间6~16个月,无再次假性动脉瘤破裂出血,肝总动脉覆膜支架置入患者于8个月猝死,原因未明。结论:腹腔干分支假性动脉瘤消化道瘘是腹部手术后罕见而又致命的并发症,应提高该病的认识,其诊断及治疗首选动脉造影及血管腔内治疗,避免医源性损伤可能是减少该病发生的关键。     

经导管肝动脉α-氰基丙烯酸正丁酯胶栓塞治疗肝内出血

目的探讨以α-氰基丙烯酸正丁酯胶(NBCA)作为栓塞剂经导管肝动脉栓塞治疗肝内出血的价值。方法收集接受经导管肝动脉栓塞治疗的肝动脉出血患者7例,均使用NBCA作为栓塞剂,评价技术成功率、临床有效率及相关并发症。结果造影显示假性动脉瘤6例,对比剂外溢1例。对7例患者均成功施行经导管肝动脉栓塞术,术后即刻造影假性动脉瘤和对比剂外溢征象消失,技术成功率100%;NBCA及超液化碘油混合剂用量为(0.76±0.24)ml;术后患者腹痛症状缓解,血红蛋白浓度升高,临床有效率100%。未发生手术相关并发症,随访1个月无再出血病例。结论采用NBCA胶行经导管肝动脉栓塞治疗肝内出血安全有效,具有重要临床应用价值。     

创伤性假性动脉瘤的腔内介入治疗

目的探讨创伤性假性动脉瘤(TPA)血管腔内治疗方法及疗效。方法回顾性分析2009年6月至2016年7月解放军第148医院收治的28例TPA患者临床资料,其中TPA位于四肢动脉13例,颈内动脉2例,肾动脉5例,胆囊动脉2例,臀上动脉2例,髂总动脉1例,肠系膜上动脉1例,脾动脉1例,阴茎动脉1例。17例主干型假性动脉瘤采用覆膜支架腔内隔绝术或多层裸支架植入术,11例终末型假性动脉瘤采用弹簧圈栓塞术。结果 28例患者腔内介入治疗均取得成功,假性动脉瘤均消失。17例植入支架者术后远端动脉搏动正常,无重要分支动脉闭塞,11例弹簧圈栓塞者术后出血停止,未出现脏器缺血坏死。术后随访6~39个月,平均(18.9±10.7)个月,失访1例,所有随访患者假性动脉瘤未复发,支架植入患者血管通畅,未发现支架移位、断裂,弹簧圈异位等并发症。结论根据假性动脉瘤位置、类型和侧支循环等选择不同的介入方法治疗TPA,具有微创操作简单、手术成功率高、并发症少、疗效确切的优点,可作为TPA的一线治疗方法。     

Arteriographic embolization of visceral artery pseudoaneurysms

The purpose of this study was to determine the safety and efficacy of transcatheter embolization in the management of bleeding visceral artery pseudoaneurysms. Eight patients (four women and four men) whose mean age was 61.0 years (range 44 to 77 years) underwent emergency transcatheter embolization for acute hemorrhage from a visceral artery pseudoaneurysm. Arteriographic technique was used to localize and selectively embolize these seven visceral artery pseudoaneurysms (three inferior pancreaticoduodenal, one gastroduodenal, two hepatic, and one splenic) by means of intravascular steel coils. Arteriography demonstrated visceral artery pseudoaneurysms in all eight patients. Acute hemorrhage was documented by endoscopy, falling hematocrit levels, CT scans, and arteriography. Successful embolization of these visceral artery pseudoaneurysms was achieved in seven (88%) of eight patients. In one patient embolization was not attempted because of a worsening clinical status, and this patient subsequently underwent emergency surgical resection. There was no significant morbidity associated with the procedures and seven patients remain asymptomatic with no further bleeding at a mean follow-up of 21.1 months (range 11 to 46 months). Arteriographic embolization of visceral artery pseudoaneurysms is a safe and highly successful technique for the effective identification and treatment of hemorrhage even in critically ill patients.     

Clinical efficacy of transcatheter embolization of visceral artery pseudoaneurysms using N-butyl cyanoacrylate (NBCA)

PurposeTranscatheter endovascular embolization within a reasonable time before rupture or deterioration of a patient's general condition is an important procedure for managing visceral pseudoaneurysms. N-butyl 2-cyanoacrylate (NBCA, enbucrilate) is an embolic material used in the blockade of visceral pseudoaneurysms. This study evaluated the clinical efficacy of transcatheter embolization of visceral artery pseudoaneurysms using NBCA.Patients and methodsBetween June 2004 and February 2014, 13 patients (9 males and 4 females; age range, 26–80 years; mean, 57.9 years) with 14 pseudoaneurysms were treated by transcatheter embolization using NBCA. NBCA was mixed with iodized oil at a 1:3 ratio to control its polymerization time and to render it radiopaque. Pseudoaneurysms were located on the gastroduodenal artery (n = 1), pancreaticoduodenal artery (n = 2), dorsal pancreatic artery (n = 1), proximal jejunal artery (n = 1), colic artery (n = 1), splenic artery (n = 3), renal artery (n = 4; two in one patient), and hepatic artery (n = 1).ResultsAll patients recovered immediately following the embolization procedure, and two patients showed minor complications that required only medical observation.ConclusionsTranscatheter embolization using NBCA for the treatment of visceral pseudoaneurysms is a safe, effective, and low-cost treatment method with a high success rate.     

Control of renal arterial bleeding after percutaneous biopsy

Transcatheter arterial embolization is becoming an accepted method of controlling massive acute hemorrhage, including that secondary to blunt and penetrating renal trauma. Two patients with retroperitoneal bleeding postrenal biopsy and angiographically proved pseudoaneurysms at the biopsy sites had successful embolization without sequelae. Experimental and clinical experience with transcatheter embolization is reviewed. It appears that this modality is a safe, effective way of controlling renal hemorrhage.     

超选择性动脉栓塞对外伤性肝破裂假性动脉瘤的应用价值

目的探讨超选择性动脉栓塞对外伤性肝破裂假性动脉瘤的临床应用价值。方法对20例经MSCT扫描确诊为外伤性肝破裂假性动脉瘤的患者行介入栓塞治疗,栓塞材料采用COOK弹簧圈。术后第3天、第1个月及第3个月复查MSCT及肝功能。结果 20例MSCT检查发现肝破裂假性动脉瘤,DSA检查表现为肝内动脉瘤样扩张并见对比剂外溢征象。20例栓塞治疗后出血均立即停止,瘤样扩张的血管消失。随访3个月,无复发出血,未见严重并发症。肝功能介入治疗前与术后第3天对比无明显改变,且经保肝治疗后肝功能于术后第1个月均恢复正常。结论超选择插管介入治疗外伤性肝破裂假性动脉瘤安全、迅速、有效,并能最大限度保护肝脏功能。     

胰十二指肠动脉瘤合并腹腔干动脉狭窄的介入治疗：附6例报告

目的:探讨胰十二指肠动脉瘤(PDAA)合并腹腔干动脉狭窄的治疗时机及方式的选择。方法:回顾性分析6例PDAA患者临床资料,其中4例因动脉瘤破裂出血,2例未出血被偶然发现,6例均合并腹腔干动脉狭窄或闭塞,所有患者行腔内动脉瘤栓塞治疗。结果:6例患者中,男5例,女1例;年龄42～81岁,平均59.8岁;瘤径8～21 mm,平均14.6 mm;2例为真性动脉瘤,4例为假性动脉瘤;4例位于胰十二指肠下后动脉,2例位于胰十二指肠下前动脉;5例患者有腹腔干动脉狭窄,狭窄率68%～92%,平均81%,1例完全闭塞。6例患者均行PDAA弹簧圈栓塞术,腹腔干动脉狭窄均未处理,手术时间60～110 min,平均(76.7±13.5)min;4例破裂患者栓塞治疗后出血停止,2例未破裂动脉瘤栓塞后瘤体消失,术后患者住院时间7～13 d,平均(10±2.3)d。随访9～15个月,未出现动脉瘤复发及内脏缺血表现。结论:PDAA合并腹腔干动脉狭窄单独行动脉瘤栓塞治疗是安全有效的,腹腔干动脉狭窄不处理并未出现内脏缺血表现,也未增加动脉瘤复发的风险。     

内脏动脉瘤的外科治疗

目的 探讨内脏动脉瘤的外科治疗方法。方法 回顾性分析2002年2月至2010年6月收治的19例内脏动脉瘤患者外科治疗的临床资料,包括脾动脉瘤7例、肝右动脉瘤1例、胃左动脉瘤1例、胰十二指肠动脉瘤3例、胃十二指肠动脉瘤2例、肠系膜上动脉瘤、结肠中动脉瘤和左结肠动脉瘤各1例、肾动脉瘤2例。其中破裂12例。按照手术方式分为两组,介入栓塞治疗组13例,开放手术组6例。结果 4例栓塞后再出血,2例行手术探查止血、2例行二次栓塞后都得以成功止血。8例动脉瘤破裂伴休克患者术后均停止出血。1例胰十二指肠动脉瘤栓塞后出现十二指肠不全梗阻。2例脾动脉瘤患者术后出现部分脾梗死。术后随访18例,随访2 ～ 103个月,无动脉瘤复发。结论 以支配脏器和动脉解剖的特点作为内脏动脉瘤选择手术方案的主要依据。腔内治疗和开放手术在治疗内脏动脉瘤方面均有效,而对于假性动脉瘤破裂患者,腔内治疗效果满意。     

The diagnosis and endovascular management of superior mesenteric artery (SMA) branch pseudoaneurysms after appendicectomy

Pseudoaneurysms arising from the visceral arteries are rare. We present 2 patients who developed pseudoaneurysms arising from branches of the superior mesenteric artery (SMA) following laparoscopic appendicectomy. Both cases were successfully treated by endovascular embolization. The diagnosis and management of SMA branch pseudoaneurysms are discussed.     

血管内介入治疗腹腔内脏动脉瘤11例经验

目的评价介入治疗腹腔内脏动脉瘤的安全性和疗效。方法用介入技术治疗腹腔内脏动脉瘤11例,包括脾动脉瘤5例,胃-十二指肠动脉瘤5例,肠系膜上动脉(SMA)瘤1例。5例以假性动脉瘤破裂出血就诊,3例表现为上腹部疼痛和搏动性包块,3例无自觉症状。10例用血管内栓塞术,1例发自SMA的动脉瘤用联合动脉内栓塞和被覆膜支架置入术治疗。结果11例均治疗成功,无并发症。5例以出血为首发症状者,术后出血立即停止。1例SMA动脉瘤术后被完全封闭,主干及分支显影正常。3例术前有症状者术后腹痛逐渐消失、包块缩小。随访4～52个月(平均25.5个月),未发生与动脉瘤相关的并发症,超声波检查无动脉瘤复发表现。结论血管内介入技术是治疗腹腔内脏动脉瘤的安全有效方法。     

Successful angioembolization of renal artery pseudoaneurysms after blunt abdominal trauma

We report a case of minimally invasive management of renal artery pseudoaneurysms after blunt abdominal trauma. A 44-year-old man developed gross hematuria after a motor vehicle collision. The initial radiographic evaluation revealed only a parenchymal laceration of the right kidney, and the patient was treated conservatively. Persistent gross hematuria necessitated repeat renal angiography that revealed numerous small pseudoaneurysms. Angioembolization was successfully performed with minimal compromise of the renal parenchyma. Transcatheter embolization is safe and effective for controlling hemorrhage from traumatic renal artery pseudoaneurysms and should be the initial treatment of choice in hemodynamically stable patients.