肝动脉造影联合栓塞治疗对肝动脉假性动脉瘤的诊疗价值

目的探讨肝动脉造影联合介入栓塞诊断和治疗肝动脉假性动脉瘤的临床价值。方法回顾性分析2009年1月~2017年3月本院收治的19例肝动脉假性动脉瘤患者的临床及影像学资料。12例发生于腹部肿瘤术后,3例发生于胆系结石术后,2例发生于外伤后,1例发生于肝动脉化疗栓塞术后,1例有肾移植术病史。所有患者均行选择性肝动脉造影检查。结果假性动脉瘤发生于肝内动脉的9例,7例采取明胶海绵联合弹簧圈栓塞,1例采取弹簧圈栓塞治疗,1例采取聚乙烯醇颗粒栓塞治疗;发生于肝外动脉的10例,8例采取弹簧圈栓塞治疗,1例采取明胶海绵联合弹簧圈栓塞,1例因载瘤动脉痉挛伴夹层而行保守治疗。术后随访中1例患者于栓塞术后第21天因弹簧圈移位导致假性动脉瘤复发,再次行介入栓塞治疗,4例患者失访,其余13例患者均未出现介入栓塞术后相关并发症。结论选择性肝动脉造影联合经导管动脉栓塞是诊治肝动脉假性动脉瘤安全有效的方法 。

Value of hepatic arteriography combined with embolization in the diagnosis and treatment of hepatic artery pseudoaneurysm

Objective To investigate the clinical value of hepatic arteriography combined with embolization in the diagnosis and treatment of hepatic artery pseudoaneurysm (HAPA). Methods The clinical and imaging data of 19 patients with HAPA admit-ted to our hospital from January 2009 to March 2017 were retrospectively analyzed. HAPA developed after surgery for abdominal tu-mors (12) or cholangiolithiasis (3), trauma (2), hepatic arterial chemoembolization (1), and renal transplantation (1). All 19 patients underwent selective hepatic arteriography. Results 9 patients with intrahepatic pseudoaneurysms were treated with gelatin sponge combined with coil embolization (7), coil embolization (1), and polyvinyl alcohol particle embolization (1). 10 patients with extrahep-atic pseudoaneurysms were treated with coil embolization (8) or gelatin sponge combined with coil embolization (1) whereas 1 patient underwent conservative treatment due to spasm and dissection of the parent artery. During the postoperative follow-up, 1 patient un-derwent further interventional embolization because of recurrent pseudoaneurysm secondary to coil shift on postoperative day 21, 4 patients were lost to follow up, and the other 13 patients did not present any postoperative complications related to interventional em bolization . Conclusion Selective hepatic arteriography combined with transcatheter arterial embolization is effective and safe for diagnosing and treating HAPA.