经导管血管内栓塞治疗肝动脉假性动脉瘤的疗效观察

目的 评价血管内栓塞治疗肝动脉假性动脉瘤(HAPA)的疗效和对肝功能的影响.资料与方法 8例HAPA患者行选择性腹腔动脉造影明确动脉瘤的部位后,再超选择至载瘤动脉进行血管内栓塞治疗.栓塞术后随访3～60个月,观察临床和肝功能情况.结果 8例血管造影均明确诊断.其中肝外型4例,肝内型4例;7例用弹簧圈或微弹簧圈栓塞,1例单纯明胶海绵颗粒栓塞.栓塞术后造影复查8例HAPA均消失.动脉瘤破裂出血患者出血均停止.阻塞性黄疸的患者术后1周黄疸消褪.1例单纯明胶海绵颗粒栓塞者术后3天出血复发;7例钢圈栓塞者无出血和HAPA复发,影像学复查4例HAPA消失,3例HAPA缩小、机化.肝功能检查,2例转氨酶一过性轻度升高谷-草转氨酶(AST)达286 U/L,谷-丙转氨酶(ALT)达103 U/L)],2例栓塞前肝功能异常栓塞后1周恢复正常;余4例肝功能无异常改变.结论 弹簧圈血管内栓塞治疗HAPA疗效好、并发症少.选择性肝动脉弹簧圈栓塞,对肝功能无明显影响.

The Value of Transcatheter Embolization in Hepatic Artery pseudoaneuryms

Objective To evaluate the therapeutic value and affect for liver function of transcatheter embolization in patient with hepatic artery pseudoaneuryms. Materials and Methods 8 patients with hepatic artery pseudoaneuryms were performed to selective angiography and treated with transcatheter embolization. 3 to 60 months was followed up to observe clinical effect and liver function after transcatheter embolization. Results Angiography clearly showed location, formation or fending artery of pseudoaneurym in 8 cases. The pseudoaneuryms located at extrahepatic area in 4 cases and located at intrahepatic area in 4 cases. Repeated angiography depicted complete obliteration of the pseudoaneuryms after embolization in all patients. The patients with ruptured pseudoaneuryms active bleeding were stopped immediately after embolization. 7 patients who were embolized by use of coils or microciols were not reoccurred of pseudoaneuryms or active bleeding. 1 patient who was embolized by use of gelatin sponge occurred rebleeding 3 days after the embolization. Pseudoaneuryms disappeared in 4 cases. The pseudoaneuryms became shrunk in 3 cases. 2 patients had a temporary increase of transaminases. Liver function recovered to normal in one week after embolization in 2 cases. The liver function was normal in 4 cases. Conclusion Coils embolization is a safe and effective treatment for the patients with hepatic artery pseudoaneuryms. Liver function is not significant influenced after selective hepatic artery embolization.