重症急性胰腺炎并发腹腔内出血19例临床分析

目的：探讨重症急性胰腺炎引起的腹腔内出血的原因和治疗经验。方法：回顾性分析1997年3月～2007年3月19例重症急性胰腺炎引起的腹腔内出血病例的临床资料。结果：19例患者中死亡9例，总病死率为47．4％。其中行经皮穿刺出血动脉栓塞术（TAE）11例中死亡4例（36．4％），手术8例中死亡3例（37．5％），TAE失败5例中死亡2例（40．0％）。结论：重症急性胰腺炎引起的腹腔内出血的原因以胃十二指肠黏膜糜烂和溃疡出血为主；TAE是治疗重症急性胰腺炎造成的腹腔内出血的简便、安全、有效的方法。     

重症急性胰腺炎胰源性门静脉高压并发消化道出血(附5例诊治体会)

目的总结重症急性胰腺炎(SAP)胰源性门静脉高压并发消化道出血的病因、诊断和治疗经验。方法回顾性分析2002-11~2004-11间5例SPA胰源性门静脉高压并发消化道出血病人的临床资料,统计分析发生出血时间、出血量,治疗方法采用经导管动脉(出血处)栓塞术(TAE)止血,再行脾切除术治疗。结果出血多发生在SAP发病后6~8周,出血量平均1800mL。治疗采用TAE加脾动脉栓塞,均获暂时止血效果,2例复发出血病例再次栓塞,1例成功,1例死亡。存活的4例均行脾切除术后治愈。结论胰源性门静脉高压并发消化道出血是SAP后期少见并发症,选择性动脉造影是诊断胰源性门静脉高压的首选方法;对合并消化道大出血病人,TAE加脾动脉栓塞为首选治疗方法;胰源性门静脉高压最有效的治疗是脾切除。     

内镜下钛夹标记在消化性溃疡出血经导管栓塞治疗中的临床作用分析

  目的  探讨消化性溃疡出血内镜治疗失败后,钛夹标记引导经导管栓塞治疗的可行性及临床效果。  方法  纳入2009年2月?2018年10月于四川大学华西医院因消化性溃疡出血内镜治疗失败后行经导管栓塞治疗的33例患者为研究对象,观察内镜治疗失败后行经导管栓塞治疗的临床成功率、30 d死亡率及并发症发生情况。  结果  33例患者内镜检查溃疡出血Forrest分级分别为Ⅰa 8例（24.2%）、Ⅰb 14例（42.5%）、Ⅱa 4例（12.1%）、Ⅱb 7例（21.2%）。8例患者视野差未行内镜治疗,25例患者接受内镜治疗,其中7例初次内镜止血治疗失败,18例内镜下止血成功后发生再出血。内镜治疗失败后距经导管栓塞治疗的平均时间为（35.42±67.54） h。所有患者均行血管造影检查,15例血管造影阴性患者X线下8例可见钛夹标记,钛夹引导下行栓塞治疗,7例未见钛夹标记,其中4例患者接受预防性栓塞治疗;余18例血管造影阳性者均予以栓塞治疗。血管造影阴性的患者钛夹引导经导管栓塞治疗临床治疗成功率为75.0%（6/8）,无钛夹引导者临床治疗成功率为为28.6%（2/7）,血管造影阳性者经导管栓塞治疗临床治疗成功率为66.7%（12/18）。本研究纳入的患者经导管栓塞治疗总体临床成功率为60.0%,30 d死亡率为20.0%,所有患者均未观察到栓塞治疗相关并发症。  结论  消化性溃疡出血内镜治疗失败患者,钛夹标记引导经导管栓塞治疗是一种行之有效并且安全性高的治疗方式。     

介入治疗动脉性消化道出血的观察及护理

目的探讨介入治疗动脉性消化道出血的护理方法。方法对28例消化道出血患者进行血管造影检查,对有阳性发现的病例行药物灌注或栓塞治疗。结果28例动脉造影阳性发现率75%,其中16例行栓塞治疗,5例行药物灌注,均止血成功。结论做好全面、细致的观察及护理,是保证介入治疗成功的关键。     

急诊经肝动脉栓塞治疗肝癌破裂出血的临床体会

目的探讨原发性肝癌破裂出血急诊介入的临床疗效。方法回顾性分析采用介入栓塞技术对我院16例原发性肝癌破裂出血的治疗情况。结果本组病例均行TAE获得有效止血。其中2例获得Ⅱ期手术治疗，1例因术前失血过多而死于肝功能衰竭，13例多次介入肿瘤缩小。一年存活率为37．5％（6／16）。结论介入栓塞治疗急诊肝癌破裂出血创伤小，适应证广，临床疗效确切，可作为急诊肝癌破裂出血的首选治疗方法。     

两种不同术式治疗难治性鼻出血疗效比较

目的比较鼻内镜下出血灶电凝术和鼻内镜下蝶腭动脉电凝术治疗难治性鼻出血的近、远期疗效。方法对2006年1月至2009年1月82例难治性鼻出血临床资料进行分析,内镜下出血灶电凝组（直接止血组）68例。内镜下蝶腭动脉电凝组（间接止血组）21例。所有病例随访12～48个月,治疗后第3个月末,记录患者的止血情况,随访期间最末次复查记录患者的复发情况。比较两组的止血成功率和术后鼻出血复发率。结果直接止血组、间接止血组止血成功率分别为89.7％和90．5％,差异无统计学意义（X^2=0．10,P=0．918）。两组的术后复发率分别为27．9％、4．8％。差异有统计学意义（X^2-4．644,P=0．033）。结论鼻内镜下蝶腭动脉电凝术与内镜下出血灶电凝术相比较,近期疗效相当。远期疗效更佳,复发率低,为鼻内镜下不能明确出血灶或电凝术失败的鼻出血患者的治疗提供另一种选择。     

A case of intraabdominal bleeding following pancreatoduodenectomy successfully treated by transcatheter arterial embolization

A 58-year-old male underwent pancreatoduodenectomy based on a diagnosis of middle bile duct cancer. Because abdominal drainage revealed bile leakage 5 days postoperatively, leakage at the site of cholangiojejunostomy was diagnosed, and continuous aspiration was performed. Seventeen days postoperatively, pus was discharged through the abdominal drain. Because bleeding was detected by abdominal drainage, and shock ensued 20 days postoperatively, emergency abdominal angiography was carried out to identify the bleeding site. A false aneurysm in the proper hepatic artery and extravasation from the gastroduodenal artery stump were recognized, and therefore, the proper hepatic artery and common hepatic artery were embolized at a site distal to the false aneurysm using microcoils. Celiac arteriography after transcatheter arterial embolization (TAE) did not show extravasation, and revealed blood flow from the right inferior phrenic artery to the liver. Liver function was normal after TAE, and the patient recovered and was discharged from the hospital 54 days postoperatively. This paper presents a patient in whom intraabdominal bleeding due to leakage at the site of cholangiojejunostomy complicated by infection was successfully treated by hemostasis with TAE.     

明胶海绵联合聚乙烯醇对大咯血供血动脉栓塞的临床研究

目的 探讨明胶海绵（GS）联合聚乙烯醇颗粒（PVA）与单独应用GS及PVA对大咯供血动脉栓塞术的临床疗效及复发分析.方法 对95例大咯血患者,随机分成治疗组和对照组,治疗组GS联合PVA共52例,对照组1应用PVA21例,对照组2应用GS 22例.全部随访3~12个月.结果 疗组即刻止血52例,有效率为100%,复发4例（7.7%）.对照组1即刻止血为19例（90%）,复发4例（19%）;对照组2即刻止血17例（82%）,复发6例（23%）;治疗组有效率高于对照组2,复发率较对照组均低,差异有统计学意义（P〈0.05）.结论 大咯血患者GS联合PVA 栓塞所有参与病灶供血血管并对原发疾病处理,疗效显著,方法安全、持久,止血迅速,术后复发率低,有效提高大咯血介入治疗成功率.     

非静脉曲张性上消化道出血急诊内镜治疗的疗效观察

目的探讨内镜治疗非静脉曲张性上消化道出血的疗效。方法回顾性分析2010年6月～2011年6月本院收治的非静脉曲张性上消化道出血患者76例的临床资料,其中注射止血25例,钛夹止血25例,注射联合钛夹止血26例,分析比较3组患者的住院时间、输血量及再次出血发生率的差异。结果本组76例患者经过内镜止血治疗后,注射联合钛夹止血组住院时间、输血量及再次出血发生率均低于注射止血组和钛夹止血组,差异有统计学意义(P<0.05),但注射止血组和钛夹止血组间差异均无统计学意义(P>0.05)。结论非静脉曲张性上消化道出血患者急诊内镜治疗可缩短患者的住院时间,减少患者术中出血量,提高治疗效果,值得临床推广应用。     

原发性肝癌破裂出血48例诊治的临床分析

目的：总结原发性肝癌破裂出血诊治的经验。方法对48例原发性肝癌破裂出血患者的临床资料进行回顾性分析。结果保守治疗5例,其中4例保守治疗成功,1例保守治疗后经肝动脉栓塞（ TAE）治疗。 TAE治疗19例,15例治疗成功,2例自动出院,2例死于肝性脑病和肝肾功能衰竭。手术治疗24例,20例治疗成功,4例术后死于肝肾功能衰竭、肝性脑病和失血性休克。治疗总有效率为87.50％（42／48）,病死率为12.50％（6／48）。结论充分评估病情及选择适当的治疗方法对原发性肝癌破裂出血治疗有重要意义。     

Bleeding pseudoaneurysms complicating upper abdominal surgery.

OBJECTIVE: To review the management of ruptured pseudoaneurysms following upper abdominal surgery. DESIGN: Retrospective study. SETTING: Minimal access surgery centre, Hong Kong. PATIENTS: Patients who were diagnosed to have a pseudoaneurysm after undergoing major upper abdominal surgery were recruited during the period of 1998 to 2006. MAIN OUTCOME MEASURES: Success rate of haemostasis, re-bleeding rate, re-intervention rate, and mortality. RESULTS: During the study period, a total of eight patients (median age, 61 years) were managed in our department for bleeding pseudoaneurysms following cholecystectomy, gastrectomy, or Whipple's operation. Five patients underwent upper endoscopy as the initial investigation. In four of these five patients, visceral artery pseudoaneurysms were identified by angiography and haemostasis was achieved without re-bleeding. The one for whom angiographic identification of the bleeding source failed, was successfully treated subsequently by open plication. In three other patients, open surgical haemostasis was resorted to and achieved in two of them. However, one of the latter had re-bleeding, which was successfully treated by embolisation. The one who failed open identification of the bleeding source, was eventually also treated successfully by embolisation. The overall success rates of embolisation and open surgery were 80% and 67%, respectively, and the re-bleeding rates were 0% and 33%, respectively. The corresponding mortality rates were 20% and 33%; both deaths were associated with multi-organ failure. There were no procedure-related complications following embolisation. CONCLUSIONS: Based on our experience, visceral angiography can enable the diagnosis and treatment of ruptured pseudoaneurysm in a single session. The procedure is safe, the re-bleeding rate is low, and it is as effective as alternative treatments, and should be considered a first-line intervention in patients with bleeding pseudoaneurysms complicating upper abdominal surgery.     

介入栓塞治疗难治性头颈部出血的疗效研究

目的:分析难治性头颈部出血的造影特征并评价介入栓塞治疗的安全性及有效性?方法:2009年1月—2015年3月,48例难治性头颈部出血患者在本院接受介入栓塞治疗?回顾性分析其临床资料,根据良恶性病因?造影的阳性和阴性结果等指标,分类评价介入栓塞治疗难治性头颈部出血的有效性及并发症情况?结果:48例患者中恶性病变15例,良性病变33例;造影阳性36例,造影阴性12例,恶性病变与良性病变造影阳性率无统计学差异(P=0.106)?12例造影阴性患者中特发性鼻出血占8例,其余病因者4例,特发性鼻出血造影阴性率高于其余病因(P=0.001)?46例患者成功止血,1例术后出现视野缺损并发症,5例复发,恶性病变组与良性病变组或造影阳性组与阴性组之间出血复发率无统计学差异(P=0.339和P=0.785)?结论:介入栓塞治疗难治性头颈部出血安全有效;特发性鼻出血患者造影阴性率高,进行双侧蝶腭动脉经验性栓塞同样有较好的止血效果?     

内镜下微波治疗消化性溃疡出血48例

目的:用微波治疗消化性溃疡出血的临床疗效。方法:选择48例消化性溃疡出血,在内镜下用微波反复操作达到止血。结果:一次止血成功率达100％,再次出血给予同样治疗仍有效。结论:用微波止血,方法简单,疗效高,易于推广。     

3例痔术后难治性出血患者介入治疗的即刻疗效与长期预后

目的 探讨痔手术后难治性出血经介入治疗的即刻疗效及长期预后。方法 回顾性分析3例行介入治疗的痔手术后反复多次出血患者的临床资料,随访时间分别为114个月、110个月、78个月,3例患者均经造影后明确出血部位,分别为左侧直肠上动脉分支末端造影剂外溢、直肠上动脉分支末端造影剂外溢和左侧髂内动脉末端血管造影剂外溢;2例一次栓塞成功,1例栓塞后再次出血行第二次介入治疗后成功止血。3例患者经介入治疗后均未再出血。结果 3例患者均止血确切,无肠坏死、死亡等严重并发症,均有肛门下坠、疼痛症状;1例出现阴囊水肿、勃起障碍,长期随访后又恢复。结论 介入栓塞治疗难治性痔术后持续性出血,即刻疗效显著,但安全性需要多中心及大样本的长期随访与观察。     

Role of interventional endovascular therapy for delayed hemorrhage after pancreaticoduodenectomy

Background Delayed massive hemorrhage （DMH） after pancreaticoduodenectomy （PD） is a sedous complication and one of the most common causes of mortality after PD. Its ideal management remains unclear. This paper is to present our experience in the endovascular treatment of patients with DMH after PD using different techniques and materials.Methods During a seven years period, 19 patients （fifteen men, four women） with DMH arter PD were treated with endovascular procedures, including transcatheter arterial embolization （TAE） with coils embolization in eight cases, with coils plus N-butyl-2-cyanoacrylate （NBCA）-Lipiodol mixture in six cases, and stent-graft placement in five cases. The mean age of the patients was 58.2 years. Follow-up, including clinical condition, liver function tests, and Doppler ultrasound examinations, was documented.Results The immediate technical success rate was 84.2% （16/19）. There were no significant procedure-related complications. Hemostasis was not achieved with interventional procedures in three patients： one died of uncontrolled bleeding four days after the second TAE, and two patients required emergency laparotomy without re-angiography because of worsening clinical status. Among the 16 patients with successfully stopped bleeding who became hemodynamically stable after the procedure without evidence of further bleeding, two patients died during the peri-interventional procedure period because of multiple organ failure, and fourteen patients survived to hospital discharge. The mean length of follow-up was 14.6 months. Recurrent bleeding after discharge did not occur in any of these cases. Clinical and laboratory follow-up findings were unremarkable. Doppler ultrasound examinatation verified patency of the hepatic artery in the four patients with stent-graft placement during the follow-up period （5 months-29 months; mean, 15.3 months）.Conclusions Interventional endovascular procedure is a safe and technically feasible solution to control DMH. The first-line treatment for the bleeding is TAE. Stent-graft placement with preservation of the organ arterial flow, if technicallypossible, is a valuable alternative to TAE and surgical intervention for management of DMH.     

急诊内镜治疗非静脉曲张性上消化道出血临床疗效观察

目的:探讨急诊内镜在急诊非静脉曲张性上消化道出血中的临床疗效。方法:选择急性非静脉曲张性上消化道出血患者46例,观察组23例实施急诊内镜检查治疗,对照组23例行择期内镜检查治疗,比较两组上消化道出血病因检出率及输血治疗率、内镜止血成功率、再出血发生率、住院时间等情况。结果:主要病因为消化性溃疡,23.91%(11/46),其次是急性胃黏膜病变21.74%(10/46),两组急性胃黏膜病变检出率、输血率、再出血发生率、住院时间比较,观察组显著优于对照组(P<0.05)。结论:急诊内镜能够提高上消化道出血病因的确诊率,减少输血率和再出血发生率,缩短住院时间,对于治疗方案的选择有重要指导意义。     

肝癌自发破裂出血的DSA表现及介入性治疗

目的:探讨肝癌自发破裂出血的DSA表现及其介入性治疗的临床价值。方法:搜集经B超、CT及临床证实15例肝癌自发破裂出血的介入治疗资料,着重分析其DSA表现,根据肿瘤部位、大小、供血动脉及门脉情况行肝动脉及肝外动脉肿瘤血管的化疗及栓塞治疗,并观察治疗效果。结果:DSA显示原发性巨块型肝癌12例,结节型3例;肝癌肿块多较大,直径5~15 cm不等;14例肿瘤明显外突于肝脏表面;15例肿瘤血管丰富,瘤内可见大小不等血窦,其中4例肿瘤包膜下边缘不光整,肿块内充盈缺损;7例肿瘤包膜下呈小斑点状或沿肝包膜下呈线状影;1例胆道和肠道显影;4例肝外动脉供血。15例经16次介入治疗后全部止血,其中3例于化疗栓塞后行部分肝切除,无住院死亡者。结论:肝癌自发破裂出血的DSA表现有其自身特征,可为本病的诊断和治疗提供参考依据,肝动脉化疗栓塞术是治疗肝癌自发破裂出血安全、有效的方法。     

不同麻醉方式对内镜下探查成人鼻腔后部出血点效果分析

目的研究利多卡因/肾上腺素表面麻醉和全身麻醉2种不同麻醉方式对成人后鼻腔出血内镜探查术中出血点发现率的影响。方法根据患者意愿及病情情况将164例后鼻腔出血患者分为表面麻醉组118例和全身麻醉组46例,分别在利多卡因/肾上腺素表面麻醉（1%利多卡因+0.01%肾上腺素配比液10ml,用棉片收缩鼻腔黏膜及表面麻醉）,或全身麻醉（在全麻基础上使用0.01%肾上腺素配比液10ml,用棉片收缩鼻腔黏膜）下施行内镜探查止血术。观察2种麻醉方式在出血点发现率、术后鼻腔填塞情况以及单次手术治愈率方面的差异。结果表面麻醉组术中发现确切出血点80例,术后鼻腔填塞16例,单次手术治愈102例;全身麻醉组术中发现确切出血点22例,术后鼻腔填塞17例,单次手术治愈36例。表面麻醉组术中出血点的发现率为67.80%,全身麻醉组为47.83%（P＜0.05）。表面麻醉组术后鼻腔填塞比例为13.56%,全身麻醉组为36.96%（P＜0.05）。结论在鼻内镜探查止血术中,利多卡因/肾上腺素表面麻醉下探查鼻腔出血点的成功率显著高于全身麻醉,有利于降低术后鼻腔填塞率,促进患者康复。     

内镜下组织胶注射联合套扎术治疗食道胃底静脉曲张出血的疗效观察

目的 探讨食道静脉曲张套扎术联合胃底静脉曲张组织治疗术治疗肝硬化食道胃底静脉曲张急性出血的的临床意义.方法 56例确诊肝硬化门脉高压食道或胃底静脉曲张急性出血的患者,于出血24 h内行食道静脉曲张套扎术联合胃底静脉曲张组织胶注射治疗,术后1、3、6个月行内镜随访,观察再出血率、食道胃底静脉曲张好转情况.结果 56例病人全部止血成功,1个月内再发出血5例,3例为排胶期轻度渗血,2例出血量较大,5例病人重新进镜行内镜下喷洒正肾液后血止;6个月内复查无再出血发生.食道静脉曲张治疗有效率为96%,胃底静脉曲张治疗有效率为95%.结论 肝硬化食道胃底静脉曲张急性出血应用内镜组织胶注射联合曲张静脉套扎术是一种安全、疗效肯定的的治疗方法.     

内镜下单纯套扎治疗食管曲张静脉24例临床分析

目的评价内镜下单纯套扎术治疗食管静脉曲张的临床疗效及安全性。方法回顾性分析2002年1月至2008年5月间接受单纯EVL治疗的24例患者的临床资料,评价EVL治疗的曲张静脉消失率、再出血率及并发症等。结果曲张静脉总体消失率为54．17％,1年内再出血率为33．3％,部分患者术后出现轻度的胸骨后烧灼样不适及吞咽困难,可自行缓解,无严重并发症发生。结论单纯套扎治疗曲张静脉安全、有效,但其临床疗效有待进一步提高。