医源性胆道出血的血管造影表现和介入治疗

目的评价医源性胆道出血中血管造影诊断及介入栓塞治疗的价值。方法回顾性分析医源性胆道出血患者21例。经皮选择性肠系膜上动脉、腹腔动脉和肝总动脉造影,明确出血的部位后,进行选择性或超选择性插管及栓塞治疗。结果 21例患者血管造影均证实有出血病变。血管造影表现为假性动脉瘤者17例(81.0%),对比剂外溢者4例(19.0%)。栓塞材料采用PVA颗粒栓塞者2例,单纯弹簧圈8例,明胶海绵颗粒+弹簧圈11例。1次栓塞止血成功率为85.7%(18/21),3例患者栓塞后再次大出血而行第2次栓塞成功。术后随访5～28个月,患者均未再发胆道出血。所有患者介入栓塞术后均未出现异位栓塞、肝功能衰竭、栓塞所致感染等严重并发症。结论经皮选择性血管造影和介入栓塞术微创、安全、可靠且疗效确切,是诊断和治疗医源性胆道出血的首选方法。

The angiographic findings and interventional treatment of the iatrogenic hemobilia

Objective To evaluate the angiography and interventional embolization in diagnosing and treating the iatrogenic hemobilia.Methods A total of 21 patients with iatrogenic hemobilia were enrolled in this study.The clinical data were retrospectively analyzed.Percutaneous selective superior mesenteric artery angiography,celiac angiography and common hepatic artery angiography were carried out in all patients.After the bleeding sites were clarified,selective or super-selective catheterization and embolization were performed.The clinical results were analyzed.Results Active bleeding was confirmed by angiography in all the 21 cases.Angiographic findings included pseudoaneurysm(n = 17,81.0%) and extravasation of contrast medium(n = 4,19.0%).The embolic agents used in this study included polyvinyl alcohol particles(n = 2),pure coils(n = 8) or Gelfoam particles plus coils(n = 11).The success rate of hemostasis after single embolization was 85.7%(18/21),and second embolization procedure had to be carried out in three patients as recurrent massive bleeding occurred in them.All the patients were followed up for 5 to 28 months,and no recurrent hemobilia was observed.No serious complications such as non-targeted vessel embolization,liver function failure,embolization-related infection,etc.occurred.Conclusion For the treatment of iatrogenic hemobilia,percutaneous selective angiography together with interventional embolization is safe,minimally-invasive,reliable and effective,and this technique should be regarded as the treatment of first choice.(J Intervent Radiol,2012,21: 23-26)