胆囊切除术后出血的血管造影与介入治疗体会

目的研究胆囊切除术后腹腔出血选择性动脉造影的诊断价值及介入治疗的方法和意义。方法经选择性动脉DSA后明确胆囊切除术后出血部位共9例。对明确出血部位的5例行出血动脉栓塞术。造影阴性4例转行外科手术。结果9例中5例有血管异常改变,均为动脉性出血,表现为对比剂外溢,行靶血管栓塞术后出血停止,无复发。4例造影阴性,行外科剖腹探查术明确为静脉性出血后止血治愈。结论胆囊切除术后动脉性腹腔出血的患者DSA检查对诊断出血部位指导介入栓塞治疗有重要的临床价值。介入栓塞治疗安全、有效。

Angiographic diagnosis and transcatheter therapy of hemorrhage after cholecystectomy

Objective To evaluate the clinical value of angiographic diagnosis and effectiveness of transcatheter therapy in hemorrhage after cholecystectomy. Methods The site and cause of hemorrhage after cholecystectomy were verified by selective DSA in 5 patients and then followed by treatment with target artery embolization. The cause of hemorrhage after cholecystectomy wasn't verified by selective DSA in 4 patients,surgical resection was then carried out. Results Nine cases had hemorrhage with various degrees after cholecystectomy. 55.56% of them were arterial hemorrhage identified by angiography,including 5 cases treated with target artery embolization effectively without any other important complication. The other cases were cured by abdominal exploring operation totally belonged to venous hemorrhage. Conclusion DSA and interventional therapy are of great value for arterial hemorrhage after cholecystectomy,especially the method of embolization is safe and efficient.(J Intervent Radiol,2007,16: 696-698)