髂内动脉栓塞治疗产后大出血

目的探讨髂内动脉栓塞治疗产后大出血的疗效与安全性。方法用弹簧圈或(和)明胶海绵对18例产后大出血患者行髂内动脉栓塞。栓塞后4～26个月,对5例患者用16排螺旋CT盆腔扫描并行动脉血管重建,8例患者行雌二醇(E2)、促卵泡激素(FSH)、黄体生成素(LH)、泌乳素(PRL)等激素检查。结果明胶海绵栓塞者栓塞远端动脉完全开放。钢圈加明胶海绵栓塞后可出现两种情况:一是子宫以卵巢动脉供血为主,部分开放的子宫动脉供血为辅;二是子宫仍以开放的子宫动脉供血为主。8例患者激素检查均为正常,2例再妊娠,未出现严重并发症。结论髂内动脉栓塞治疗产后大出血是安全有效的。     

CTA在动脉性大出血介入栓塞治疗中的应用

目的 探讨CT血管造影（CTA）在动脉性大出血介入栓塞治疗中应用的策略及临床效果.方法 120例动脉性大出血患者在介入栓塞治疗前行CTA检查,在介入手术中寻找所有的出血动脉,并逐一进行检塞治疗.88例患者栓塞治疗2周后复查CTA检查.对CTA在动脉性大出血介入栓塞治疗中的应用效果进行回顾性总结评价.结果 120例动脉性大出血的患者在介入栓塞治疗前行动脉CTA检查,共找到162支病变的出血动脉,介入手术中共找到178支出血动脉并成功栓塞治疗.术前CTA检查诊断的准确率为91.01％（162/178）.88例患者栓塞治疗后CTA检查显示所有已栓塞的出血动脉栓塞效果良好.结论 介入栓塞治疗前CTA检查可以为栓塞治疗中寻找出血动脉提供准确的定位作用.栓塞治疗后行CTA检查有利于对栓塞疗效的准确判定.     

下消化道出血的选择性动脉造影诊断及栓塞治疗

目的 探讨下消化道出血的选择性造影表现及介入治疗的疗效。方法 1996年2月～2002年2月间，对42例下消化道出血患行选择性动脉造影，并对其中15例诊断明确患行灌注或栓塞治疗。结果 明确出血部位及病变30例，诊断准确率71．4％(30／42)，30例中，小肠出血10例，大肠20例；对其中3例肠道血管畸形患行明胶海绵栓塞治疗，成功率100％；12例行动脉内血管加压素灌注，8例出血停止，4例无效，有效率66．7％。结论 选择性血管造影是诊断下消化道出血最有效可靠的检查手段，动脉内介入治疗是一种有效的止血方法。     

经导管动脉栓塞治疗消化道动脉性出血

经导管动脉栓塞治疗消化道动脉性出血陈勇陈卫国何晓峰许小立鲁恩洁李彦豪对动脉性消化道大出血（ａｒｔｅｒｉａｌｈｅｍｏｒｈａｇｅｏｆｄｉｇｅｓｔｉｖｅｔｒａｃｔ，ＡＨＤＴ）患者行选择性动脉造影确定出血部位，然后行超选择性动脉栓塞（ｔｒａｎｓｃａｔｈｅｔｅ...     

产后大出血：卵巢动脉造影和栓塞术的意义

目的:观察卵巢动脉(OA)作为产后出血来源的血管造影表现,评价经导管栓塞OA参与出血的安全性和疗效。材料和方法:对7例OA作为产后出血来源的患者进行了选择性OA造影和栓塞术。栓塞OA的材料有明胶海绵碎粒、PVA、微型钢丝圈。结果:选择性OA造影显示造影剂外溢至宫腔6例、OA直接参与子宫异常血管供血1例。补充栓塞参与出血或病变的OA后出血立即停止,住院期间未再复发出血,未发生与栓塞术相关的并发症。结论:OA可作为产后出血的主要供血动脉,是导致常规栓塞两侧髂内动脉-子宫动脉不能控制出血的原因之一。如发现OA参与产科出血性病变的供血,补充做OA栓塞术是安全和有效的。     

急诊介入栓塞治疗消化道大出血

目的探讨消化道大出血急诊血管造影诊断和栓塞治疗的价值.方法15例消化道大出血病例,行急诊血管造影检查和栓塞治疗.男12例,女3例.采用Seldinger技术和同轴导管方法,使导管头端接近出血部位,用明胶海绵或手术用线段栓塞治疗.结果15例均成功栓塞,且即达到止血目的.血管造影均表现有造影剂外溢及脏器管腔、粘膜显影.所有病例自栓塞后未再出血.结论消化道大出血急诊介入栓塞治疗临床效果肯定,阐述了栓塞治疗原则和注意事项.     

双侧子宫动脉栓塞治疗产后大出血

产后子宫大出血是产科常见的严重并发症,发生率5％～10％,是我国产妇死亡的首要原因,迅速有效地控制产后出血是治疗的关键。对药物治疗无效的难治性产后出血患者实施经导管栓塞动脉止血具有快速、准确、创伤小的优点,本研究旨在探讨子宫动脉栓塞治疗产后子宫大出血的临床价值。     

经导管髂内动脉栓塞治疗外伤性骨盆骨折大出血

目的：探讨经导管栓塞髂内动脉治疗外伤引起盆腔大出血的临床价值。方法：23例创伤性盆腔大出血,经保守治疗无效,急诊行单侧或双侧髂内动脉造影,明确出血部位后,经导管用明胶海绵或微弹簧圈栓塞。结果：23例出血停止,休克症状消失,血压稳定上升。无1例死亡。结论：经导管栓塞髂内动脉或其分支治疗创伤性盆腔大出血快速有效,创伤小,并发症少。     

产后大出血急诊栓塞治疗的不良反应及并发症探讨

目的:探讨动脉栓塞法治疗急诊产后大出血的不良反应及并发症及其防治。方法:对57例急诊产后大出血患者的双侧子宫动脉或和髂内动脉以及部分患者的卵巢动脉用明胶海绵颗粒进行栓塞。结果:所有病例均出现有栓塞术后综合征;1例患者出现血尿(1.8%);13例患者出现髋部及下肢疼痛、麻木(22.8%);19例患者出现臀部疼痛、红肿、硬结(33.3%);1例患者出现子宫性闭经(1.8%);全组病例未出现子宫坏死或卵巢功能减退等其它严重并发症。结论:产后大出血急诊栓塞治疗会出现一定的不良反应及并发症,在治疗过程中进行超选择性栓塞,不进行过度栓塞,严防栓塞剂返流,可避免大部分严重并发症的发生。     

小肠出血栓塞治疗前后应用血管加压素安全性的研究

目的 探讨小肠出血栓塞治疗前后应用血管加压素（VS）的安全性。材料与方法 健康杂种犬7只,结扎直动脉制作肠栓塞模型。实验肠段总数28段。分A组（n=8),停用VS 30min后栓塞;B组（n=8),停用VS 2h后栓塞;C组（n=8),栓塞后立即应用VS;对照组（n=4),不应用VS。检测应用VS前后、栓塞前后正常肠壁和栓塞肠段肠壁血液pH、PO2,观察血管造影表现。1周后病检。结果 （1）直动脉栓塞后局部pH和PO2迅速下降,对照组及A、B组1h时回升,C组无回升。（2）静滴VS后栓塞区未见侧支供血。（3）病检示A、B组和对照组肠粘膜轻度损伤,C组肠粘膜中度损伤。结论 停用VS 2h后进行小肠出血栓塞治疗,其安全性不会受到影响;栓塞后立即应用VS可加重栓塞肠段的缺血性损伤。     

血管介入栓塞术治疗尿路大出血

目的:研究和评估血管介入栓塞治疗在尿路出血中的作用和价值。方法:运用血管介入栓塞术治疗35例尿路出血,其中肾外伤11例、肾肿瘤13例、膀胱肿瘤9例(3例为手术后)、前列腺癌晚期2例。栓塞材料选用明胶海绵颗粒(或明胶海绵条)、无水乙醇、超液化碘油。结果:全部病例的出血在栓塞后1～3d后完全停止,随访4个月～9年,无复发出血,且肾损伤出血患者保留了部分的肾功能。结论:血管介入栓塞治疗创伤小,疗效显著,可保留部分脏器功能,是治疗尿路大出血的安全有效的方法。     

Microcatheter Embolization of Lower Gastrointestinal Hemorrhage: An Old Idea Whose Time Has Come

Early attempts of using embolization for lower gastrointestinal hemorrhage were fraught with complications, most notably ischemic colitis or bowel infarction. Embolotherapy was eventually abandoned in favor of catheter-directed vasoconstriction (i.e., vasopressin infusion). This latter therapy is time and labor intensive. With the advent of microcatheter technology, superselective embolization emerged and is rapidly becoming the endovascular therapy of choice for patients with severe lower gastrointestinal hemorrhage refractory to medical management. Numerous studies on the subject have consistently reported high clinical success with low ischemic complications. This article will review the current status of co-axial microcatheter embolization with an emphasis on the technical aspects of the procedure.     

超选择性动脉造影、栓塞及灌注诊治难治性消化道出血的临床价值

目的：探讨选择性动脉造影、栓塞及灌注在难治性消化道大出血的临床价值。方法：２２例急性消化道大出血病人,按Ｓｅｌｄｉｎｇｅｒ′ｓ技术进行造影诊断及导管内治疗。结果：２２例中２０例显示了在造影时有造影剂外溢（９０．９％）。１７例进行了栓塞和加压素灌注的病人,１５例有效,有效率为８８．２％（１５／１７）,其余５例单纯灌注,１例有效。总效率７２．２％（１６／２２）。结论：选择性动脉造影有助于胃肠道出血的定位和定量,血管内栓塞和灌注加压素是一种少创伤和有效的止血方法。尤其是手术条件不好的病人。     

军人上消化道出血453例病因及诱因分析

目的分析军人上消化道出血病因及诱因,探讨预防军人上消化道出血的措施。方法对1990年10月—2005年9月住院的军人上消化道出血453例进行回顾性分析,统计引起出血的诱发因素及其原发疾病。结果消化性溃疡及胃黏膜糜烂为军人上消化道出血的主要病因,分别占74.0%及16.8%,66.9%有明确诱因,81.9%病例出血前有慢性消化道症状,发病有时间规律性。结论军人上消化道出血多有明确的原发疾病及诱发因素;通过积极治疗原发疾病和减少诱发因素,可有效预防军人上消化道出血的发生。     

Angiographically Negative Acute Arterial Upper and Lower Gastrointestinal Bleeding: Incidence, Predictive Factors, and Clinical Outcomes

Objective

To evaluate the incidence, predictive factors, and clinical outcomes of angiographically negative acute arterial upper and lower gastrointestinal (GI) bleeding.

Materials and Methods

From 2001 to 2008, 143 consecutive patients who underwent an angiography for acute arterial upper or lower GI bleeding were examined.

Results

The angiographies revealed a negative bleeding focus in 75 of 143 (52%) patients. The incidence of an angiographically negative outcome was significantly higher in patients with a stable hemodynamic status (p < 0.001), or in patients with lower GI bleeding (p = 0.032). A follow-up of the 75 patients (range: 0-72 months, mean: 8 ± 14 months) revealed that 60 of the 75 (80%) patients with a negative bleeding focus underwent conservative management only, and acute bleeding was controlled without rebleeding. Three of the 75 (4%) patients underwent exploratory surgery due to prolonged bleeding; however, no bleeding focus was detected. Rebleeding occurred in 12 of 75 (16%) patients. Of these, six patients experienced massive rebleeding and died of disseminated intravascular coagulation within four to nine hours after the rebleeding episode. Four of the 16 patients underwent a repeat angiography and the two remaining patients underwent a surgical intervention to control the bleeding.

Conclusion

Angiographically negative results are relatively common in patients with acute GI bleeding, especially in patients with a stable hemodynamic status or lower GI bleeding. Most patients with a negative bleeding focus have experienced spontaneous resolution of their condition.     

The Efficacy and Long-Term Outcome of Microcoil Embolotherapy for Acute Lower Gastrointestinal Bleeding

Objective

To evaluate the clinical efficacy as well as long-term clinical outcomes of superselective microcoil embolization for lower gastrointestinal bleeding (LGIB).

Materials and Methods

Between 1997 and 2009, 26 patients with intended transcatheter embolotherapy for LGIB were retrospectively reviewed. Embolization was performed only when the catheter could be advanced to or distal to the mesenteric border of the bowel. The main purpose of our study was to assess technical success, recurrent bleeding rate and complications. We also evaluated the long-term clinical outcome, including late recurrent LGIB, bowel ischemia and the survival rate.

Results

Twenty-two bleeding sources were in the territory of superior mesenteric artery and four in the inferior mesenteric artery. Technical success was achieved in 22 patients (84.6%). The target vessel of embolization was vasa recta in seventeen patients and marginal artery in the remaining five patients. Early rebleeding occurred in two patients (7.7%) and bowel ischemia in two patients, of whom the embolized points were both at the marginal artery. Delayed recurrent bleeding (> 30 days) occurred in two angiodysplasia patients. Five patients (19.2%) died within the first 30 days of intervention. Long-term follow-up depicted estimated survival rates of 58.2 and 43.1% after one, and five years, respectively.

Conclusion

Transcatheter embolotherapy to treat LGIB is effective with low rebleeding and ischemic complications. Considering the advanced age and complex medical problems of these patients, the minimal invasive embolotherapy may be used as both a primary and potentially definitive treatment of LGIB.