钢圈栓塞治疗肝动脉假性动脉瘤的临床观察

目的探讨钢圈栓塞治疗肝动脉假性动脉瘤(HAPA)的方法、安全性及中远期疗效。方法回顾分析7例以反复上消化道大出血为主要表现的患者,行腹腔动脉和肝动脉造影检查,明确HAPA诊断后,以钢圈或微钢圈超选择栓塞假性动脉瘤的供养动脉,栓塞后造影复查,并于术后观察和随访6～60个月(平均38个月)。结果血管造影前的出血量为1200～4000ml(平均2385ml),3例肝功能正常,4例肝功能异常(ALT升高2例85～156μ/L、阻塞性黄疸2例TBIL 76～112μmol/L)。动脉造影能清晰显示HAPA的位置、形态和供养血管。其中肝外型HAPA 4例,肝内型HAPA 3例,合并动门静脉瘘1例。分别以钢圈或微钢圈栓塞其供养动脉,共计应用钢圈13枚,微钢圈12枚,介入治疗成功率为100%。所有行栓塞后患者均未出现上消化道出血等临床表现,随访期内无复发出血和因栓塞引起的并发症。结论钢圈栓塞是治疗HAPA安全、有效的治疗,其中远期临床疗效肯定,无严重并发症。

Clinical observation on coil embolization in treatment of hepatic arterial pseudoaneurysm

Objective To discuss the method,mid-long term clinical therapeutic effect and safety of coil embolization in treating patients with hepatic arterial pseudoaneurysm(HAPA).Methods Seven patients with repeatedly massive hemorrhage of gastrointestinal tract were undertaken DSA of celiac arteries and hepatic arteries and embolization of the feeding artery by coils or microcoils after correct diagnosis.All cases underwent follow-up from 6 to 60 months(mean 38).Results The blood loss before angiography was ranged from 1200 to 4000(mean 2385)ml.There were 3 cases with normal hepatic function and 4 with hepatic dysfunction including ALT increase in 2 and obstructive jaundice in another.Digital substraction angiography(DSA)clearly showed the location,shape and feeding arteries of HAPA.There were 2 types of HAPA namely intrahepatic (n=3)and extrahepatic(n=4),adding one case with arteriovenous fistula(AVF).Embolization was successful in all cases by coils(n=13)or microeoils(n=12).No recurrence and any definite clinical complication occurred during follow-up.Conclusion Coil embolization in treating HAPA is safe and effective with mid-long term positive clinical therapeutic efficiency without severe complications.(J Intervent Radiol, 2007,16:803-806)