经皮肝穿刺胆管引流术后胆道大出血的介入治疗

目的探讨介入疗法治疗经皮肝穿刺胆管引流术（PTCD）后胆道大出血的临床应用价值。 方法回顾性分析2008年3月至2015年1月621例因胆道梗阻行PTCD,共发生术后胆道大出血8例（1.29%）,7例患者首选经选择性血管造影及引流管造影,证实责任血管后行介入治疗。1例先行手术探查,术后再发大出血,予血管造影检查证实假性动脉瘤后行介入治疗。 结果6例患者经造影证实为医源性血管损伤,其中2例为动脉胆管瘘,3例为假性动脉瘤,1例为门静脉胆管瘘。2例动脉胆管瘘及3例假性动脉瘤患者予栓塞责任血管近端、远端后治愈,门静脉胆管瘘患者经保守治疗后死亡。剩余2例为胆管癌栓松动后自发出血,经肝动脉栓塞后止血。 结论血管介入治疗为胆道大出血的首选治疗方法,具有安全性高、创伤小、疗效确切的优势。     

经皮肝穿刺胆管引流术后胆管大出血的介入治疗

目的探讨介入疗法治疗经皮肝穿刺胆管引流术（PTCD）后胆管大出血的临床应用价值。方法对9例PTCD术后胆管大出血患者进行选择性血管造影和引流管造影,证实责任血管后进行介入治疗。结果对2例动脉胆管瘘患者行超选择性责任血管出血点近端和远端栓塞,6例假性动脉瘤患者行超选择性动脉瘤远端、假性动脉瘤及近端栓塞,对1例胆管门静脉主干瘘患者行胆管内覆膜支架植入术。术后所有患者出血均停止,经3～6个月随访后均无再出血。结论介入疗法治疗PTCD术后胆管大出血安全有效,创伤小。     

超选择性肝动脉插管造影栓塞术治疗胆道大出血

目的 对超选择性肝动脉插管造影栓塞术治疗胆道大出血进行疗效评估。方法 回顾性分析1993年3月至2001年7月胆道大出血8例的临床资料，采用放射介入技术行腹腔动脉和选择性肝右或肝左动脉造影，随即行肝动脉分支出血点近端栓塞。结果 2例患者由于再出血而行第2次栓塞，所有患者均存活，随访2个月至7年无再出血。结论 超选择性肝动脉造影及栓塞安全，可靠微创，可作为胆道大出血的重要诊断及治疗依据。     

肝肿瘤消融相关胆道出血的临床表现及治疗

目的探讨肝肿瘤消融所致胆道出血的临床表现及治疗情况。方法回顾性分析8例肝肿瘤消融术后胆道出血患者,1例接受内科保守治疗,对4例患者行动脉栓塞治疗,3例行动脉栓塞+胆囊穿刺引流治疗。结果肝肿瘤消融术后8例胆道出血患者均无休克表现,均有腹痛,黑便7例,术中呕血2例;血红蛋白较术前下降6~62g/L(中位值18.0g/L)。4例胆红素明显升高(正常水平4倍以上)。对3例行血/尿淀粉酶检查的患者中,2例血/尿淀粉酶升高。8例患者CT图像上均见胆囊内液性高密度影。7例接受动脉造影的患者中,2例见假性动脉瘤。治疗后随访1~3个月,8例患者均恢复良好,无死亡病例。结论胆道出血是肝癌消融治疗的少见并发症,根据临床表现、实验室及影像学检查可及早做出诊断。对于出血量大或保守治疗无效的患者应及早考虑动脉栓塞,对于胆红素明显升高的患者可联合胆道引流。     

胆道大出血的介入造影诊断及栓塞治疗

目的：评价血管造影和栓塞对胆道大出血的诊断及治疗效果。方法８年间收治胆道大出血６例,均采用腹腔动脉和选择性肝右或左动脉造影,随即行肝动脉分支出血点近端栓塞。结果６例患者经这种方法治疗,出血立即停止。其中有一例患者由于再出血而行第２次栓塞,所有患者均存活,随访半年－５年无再出血,结论胆道大出血行选择性肝动脉主栓塞是安全有效的诊断及治疗方法,与手术比较,栓塞治疗具有显著优点。     

肢体创伤性动脉病变的介入诊断与治疗

目的 评价介入放射方法诊断治疗肢体创伤性动脉病变的效果。方法 8例肢体动脉创伤伴有远端肢体缺血改变，其中2例伴大出血，伤者接受了选择性患肢动脉造影检查；7例随后进行了动脉病变的血管腔内介入治疗。治疗方法包括动脉分支或主干栓塞、动脉内溶栓和血管内支架置放。结果 血管造影精确显示了动脉破裂、假性动脉瘤、血栓形成或动脉内膜损伤等病变性质。3例假性动脉瘤、3例动脉血栓病变综合应用介入治疗方法取代外科手术获得满意疗效。1例溶栓后证实动脉破裂和1例造影证实动静脉瘘后转手术治疗。结论 介入放射与外科方法相结合能明显提高肢体动脉创伤的诊断治疗水平，有效挽救伤者肢体和生命。     

Emergency intervention therapy for renal vascular injury

Objective: To evaluate the efficacy and safety of the interventional techniques in the treatment of renal vascular injury.Methods: A total of 16 patients with renal vascular injuries were treated by superselective arterial embolization.The renal injuries resulted from renal biopsy in 7 patients,endovascular intervention in 2.percutaneous puncture and pyelostomy in 2.local resection of renal tumor in 1 and trauma in 4.With regards to clinical manifestations,there was hemorrhagic shock in 8 patients,severe flank pain in 14,and hematuria in 14.CT and ultrasonography confmued that 15 Patients had perirenal hematoma.The embolization was performed with microcoils in 13 and standard stainless steel coils in 3 patients,associated with polyvinyl alcohol particles (PVA) in 9,and gelfoam particles in 6 cases.Results: Renal angiogram revealed arteriovenous fistula in renal parenchyma in 9 cases,pseudoaneurysm in 3 and extravasation of contrast media in 4.The arterial embolization was successful in all 16 cases in a single session.The angiography at the end of therapy showed that abnormal vessels had disappeared without other major intrarenal arterial branch occlusion.In 13 patients with hemodynamical compromise,blood loss-related symptoms were immediately relieved after blood transfusion.In 14 patients with severe flank pain,the pain was progressively relieved.Hematuda ceased in 14 patients 2-14 days after the embolization procedures.The renal function was impaired after the procedure in 6 cases,in which preoperative renal insufficiency was exacerbated in 3 and developed new renal dysfunction in 3.2 of whom received hemodialysis.The ultrasonography showed that perirenal hematoma was gradually absorbed within 2.6 mortths after the procedure.A11 patients were followed up in 6-78 months (mean,48 months).Six patients died of primary diseases (5 cases of renal failure and multiple organ failure and 1 case of malignant tumor).Ten patients survived without bleeding and further intervention.The deteriOration of renal function did not occur and the serum creatinine and blood urea were in normal range.Conclusion: Transcatheter selective renal arterial embolizationis a safe and effective method in the treatment of renal vascular injuries.     

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。     

Endovascular treatment of arteriovenous fistulas complicating percutaneous renal biopsy in three paediatric cases.

DESIGN: We evaluated the incidence and history of arteriovenous fistula (AVF) after kidney biopsy and assessed the use of superselective embolization for treatment. OBSERVATIONS: During the last 10 years, 896 kidney biopsies (age range of the patients: 1 month-18.6 years) have been performed in our institution under real-time ultrasonographic guidance with a 14 gauge cutting biopsy needle, and 32 of the patients had renal allografts (3.4%). We observed three cases of AVF (two in allograft kidneys, one in a native kidney) among all biopsies (0.34%), and the incidence of developing AVF after renal allograft biopsy was 6.3%. All three patients with AVF were symptomatic, and intravascular therapy was indicated. INTERVENTIONS: An angiographic study combined with endovascular treatment of the intrarenal AVF and pseudoaneurysm was performed in all three patients. Embolization was performed with bucrylate and lipiodol in two patients and with micro-coils in one. After successful embolization, all three patients became asymptomatic (in two renal bleeding stopped, in one patient with severe uncontrollable hypertension blood pressure returned to normal limits). No complications were observed secondary to the embolization procedure. CONCLUSION: The technique of superselective embolization using a coaxial catheter is an effective and safe method in the treatment of post-biopsy AVFs and pseudoaneurysm.     

Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors

PURPOSE: We identified risk factors predicting severe bleeding due to percutaneous nephrolithotomy. MATERIALS AND METHODS: Computerized data on 2,909 patients who underwent a total of 3,878 percutaneous nephrolithotomy procedures between January 1995 and December 2005 were retrospectively reviewed. Data on patients who experienced severe bleeding requiring angiographic renal embolization were compared with those on other patients using univariate and multivariate analyses. We tested the characteristics of patients, kidneys and stones together with details of the operative procedure and surgeon experience. RESULTS: Severe bleeding complicated a total of 39 procedures (1%) in 25 males and 14 females with a mean age of 50.7 +/- 12.6 years. Associated morbidity included shock in 6 patients and perirenal hematoma in 4. Renal angiography revealed pseudoaneurysm in 20 patients, arteriovenous fistula in 9, the 2 lesions in 8 and arterial laceration in 2. Bleeding could be controlled with superselective embolization in 36 patients (92.3%). Followup was available on 33 patients (mean 21 +/- 15 months). Renal function was stable in all patients except 3 who had a post-embolization increase in serum creatinine, of whom all had a solitary kidney and none required renal replacement therapy. Significant risk factors for severe bleeding were upper caliceal puncture, solitary kidney, staghorn stone, multiple punctures and inexperienced surgeon. CONCLUSIONS: Percutaneous nephrolithotomy should be performed by an experienced endourologist in patients at risk for severe bleeding, such as those with a solitary kidney or staghorn stones.     

Transcatheter arterial embolization of splenic artery aneurysms and pseudoaneurysms: short- and long-term results

We evaluated outcomes of endovascular treatment of splenic artery aneurysms and pseudoaneurysms. From April 2002 to May 2007, 17 patients (mean age 55.2 years, range 17-82) with splenic artery aneurysms (n = 7) or pseudoaneurysms (n = 10) underwent endovascular treatment. Six patients were asymptomatic, three had symptomatic nonruptured aneurysms, and eight had ruptured aneurysms. Lesions were in the proximal splenic artery (n = 5), intermediate splenic artery (n = 3), splenic hilum (n = 6), or parenchyma (n = 3). Embolization was with microcoils by sac packing (n = 8), sandwich occlusion of the main splenic artery (n = 4), or cyanoacrylate glue into the feeding artery (n = 4). Computed angiotomography was done within the first month and magnetic resonance angiography after 6 and 12 months, then yearly. Mean follow-up was 29 months (range 1-62). Exclusion of the aneurysm was achieved in 16 (94.1%) patients. One patient with an intraparenchymal pseudoaneurysm underwent splenectomy after failed distal catheterization. No major complications occurred. Postembolization syndrome developed in four patients, who had radiographic evidence of splenic microinfarcts. Transcatheter embolization of splenic artery aneurysms/pseudoaneurysms is safe and effective and may induce less morbidity than open surgery, in particular by preserving the spleen. Coil artifacts may make magnetic resonance angiography preferable over computed tomography for follow-up.     

Successful interventional treatment of renal insufficiency caused by renal artery pseudoaneurysm with concomitant arteriovenous fistula

Asymptomatic arteriovenous fistulae and pseudoaneurysms are common after renal biopsy. We present a patient with a single kidney and symptomatic pseudoaneurysm of the renal artery with concomitant arteriovenous fistula as a rare complication following surgical embolectomy. The patient developed renal insufficiency because of a significant degree of vascular steal caused by the fistula. Dialysis was performed for more than 6 months until the fistula was diagnosed. The fistula and the pseudoaneurysm were successfully treated by superselective arterial embolization with metallic coils. Renal function improved within the next 2 weeks and no further dialysis was necessary.     

医源性肾动脉损伤性出血的介入诊疗

目的探讨超选择性动脉造影与栓塞治疗医源性肾动脉损伤性出血的临床价值。方法对11例肾穿刺活检或经皮肾镜取石术后大量肉眼血尿患者实施超选择性肾动脉造影与栓塞术,栓塞材料采用明胶海绵与弹簧圈。结果 11例中,假性动脉瘤2例,动-静脉瘘2例,假性动脉瘤合并动静脉瘘5例,动脉-肾盏瘘2例;损伤血管为肾脏后段、下段动脉及其叶间动脉分支,单支血管损伤10例,多支血管损伤1例。单纯采用明胶海绵栓塞4例,单纯采用弹簧圈栓塞4例,二者联合栓塞3例,其中1例为明胶海绵栓塞24h后复发尿血改用弹簧圈栓塞。栓塞后10min造影示出血征象消失,1~3天后患者血尿逐渐消失,未发生严重并发症。结论动静脉瘘为医源性肾动脉损伤的主要表现,以单发病变多见;超选择性动肾脉造影可迅速明确诊断,超选择性肾动脉栓塞微创、安全、有效,应作为治疗医源性肾动脉损伤性出血的首选方法。     

外伤性肾动脉假性动脉瘤的诊断和治疗(附2例报告及文献复习)

目的:探讨外伤性肾动脉假性动脉瘤(Renal artery pseudoaneurysm,RAP)的诊断与治疗方法。方法:回顾性分析2例RAP患者的临床资料:均为男性,年龄分别为17岁和42岁,临床主要表现为持续性出血或迟发性肉眼血尿。血管造影示损伤动脉活动性出血,肾内见充盈造影剂的囊腔状结构。2例患者均行超选择性血管栓塞治疗。结果:2例患者术后血尿或出血均消失,无并发症发生。术后3个月以上行CT检查,肾功能均未见异常。结论:RAP临床表现为持续性出血或迟发性肉眼血尿;血管造影在诊断RAP中具有重要价值;超选择性动脉栓塞是治疗RAP的安全、有效方法。     

介入栓塞治疗子宫腺肌病探讨(附17例分析)

目的 探讨血管介入栓塞治疗子宫腺肌病的方法与疗效. 方法 17例经临床诊断为子宫腺肌病患者均行介入栓塞治疗,根据腹主动脉和双侧髂内动脉造影的表现,予超选择性子宫动脉栓塞. 结果 17例子宫腺肌病患者均成功完成双侧子宫动脉超选择性栓塞.介入手术时长平均75( 60～90) min,术中透视观察时间平均22.5(15～30) min.术后均有不同程度栓塞后综合征3～6d.随访3个月～5年,月经量明显减少,痛经及贫血症状明显缓解,月经周期恢复正常,延长的经期明显缩短,无复发病例. 结论 介入栓塞治疗子宫腺肌病具有创伤小、疗效好、子宫完整保留的优势,有望成为代替子宫切除治疗子宫腺肌病的理想方法.     

胆道大出血20例临床回顾分析

目的 探讨胆道大出血的病因、诊断与治疗。方法对1998年8月至2008年8月收治的20例胆道出血临床资料作回顾分析。结果20例均经保守治疗,4例治愈,7例行肝动脉血管造影术与栓塞术,6例止血成功,1例失败,后经手术治疗痊愈。共有10例经保守治疗无效后手术治疗,均未发生再出血,无死亡病例。结论在条件允许情况下,肝动脉血管造影与栓塞是术后胆道出血诊断治疗的首选,如果非手术治疗无效或栓塞疗法失败,则应积极手术治疗。     

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目的 评价腔内人造血管内支撑术在治疗血管外科疾病中的早期临床疗效。方法 ９例病人接受腔内人造血管内支撑术治疗。其中腹主动脉瘤６例，左锁骨下动脉瘤１例，左髂总动静脉瘘１例，左髂股动脉重度硬化性狭窄１例。术前均行Ｄｒｐｌｅｘ彩超、四肢节段性测压（ＰＶＬ）和ＤＳＡ造影，６例动脉瘤病人术前行三维重建螺ＣＴ。结果 术后即刻ＤＳＡ造影显示，７例动脉瘤消失，近远端人造血管与宿主动脉结合外均未见渗漏；１例左髂动静     

急诊介入栓塞治疗骨盆骨折小动脉损伤隐匿性出血

目的探讨急诊介入栓塞治疗骨盆骨折小动脉损伤隐匿性出血的临床价值。方法回顾性分析14例骨盆骨折小动脉损伤隐匿性出血患者的资料。14例均接受急诊介入栓塞止血,栓塞材料为明胶海绵颗粒、微弹簧圈。结果 14例动脉期造影均未见明显对比剂染色或积聚,延迟期共发现34条小动脉中远端表现为少量对比剂轻度染色或积聚,超选择性插管造影可见明显对比剂外溢。对34条出血小动脉均成功栓塞止血。术后2例患者因失血性休克、严重酸中毒及多脏器衰竭死亡。结论对骨盆骨折小动脉损伤隐匿性出血患者,超选择性介入栓塞是有效止血措施,延迟期造影有利于提高对小动脉损伤的检出率。     

肝脏创伤性假性动脉瘤和动静脉瘘的诊治

目的 探讨肝脏创伤性假性动脉瘤(post-traumatic intrahepatic pseudoaneurysm，HPA)及动静瘘瘦(arteriovenous fistula,AVF)的临床特点及诊疗手段。方法 肝创伤性HPA／AVF病人13例，对其临床资料进行回顾性总结。结果 其主要病因为严重肝破裂伤和深部肝穿刺伤(10例)，病变部位肝右叶(8例)＞左叶(3例)＞肝门部(2例)，症状以迟发性出血伴腹痛为主(11例)，诊断率贴A＞CT＞B超。治疗包括肝动脉栓塞治疗(7例)，肝叶切除(3例)，瘤体切除、肝动脉结扎(2例)，1例未做特殊治疗。结论 创伤性HPA／AVF是肝外伤后迟发出血的重要原因，肝动脉造影及栓塞术是该类疾病的主要诊疗手段。     

Percutaneous transhepatic embolization of an intrahepatic pseudoaneurysm following liver biopsy in a liver transplant patient

A 41-year-old liver transplant patient had severe hemobilia from an intrahepatic pseudoaneurysm secondary to a liver biopsy. Selective intra-arterial embolization was not technically possible due to marked redundancy and tortuosity of the allograft hepatic artery. The pseudoaneurysm was localized by ultrasound and embolized using a direct percutaneous transhepatic approach. This is a novel way of approaching hemobilia in liver transplant patients after liver biopsy and may avoid the risks of arterial embolization.