中国普外基础与临床杂志

中国普外基础与临床杂志

选择性出血动脉栓塞治疗创伤性肝脏破裂出血

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目的 探讨选择性出血动脉栓塞在处理创伤性肝脏破裂出血中的止血效果。
方法 回顾性分析2004年1月至2011年6月期间笔者所在医院收治的63例创伤性肝脏破裂出血患者的临床资料,均首先采用股动脉穿刺插管,肝动脉造影显示出血部位,然后将微导管放至出血分支动脉,注入栓塞剂,选择性栓塞止血。
结果 63例均顺利完成肝动脉造影,显示肝左动脉分支出血8例,肝右动脉分支出血39例,肝左、右动脉分支均有出血10例,6例未见明确出血。57例出血患者均完成栓塞并成功止血,其中1处栓塞36例,2处栓塞11例,3处及以上栓塞10例。6例无明确出血表现者未做栓塞。无继发出血病例,无死亡病例。栓塞后1周血红蛋白及红细胞比容基本恢复正常。63例随访0.5~1年,无肝脏再出血,肝功能正常。
结论 选择性出血动脉栓塞是治疗创伤性肝脏破裂出血的一种安全、有效以及微创的手段。

Objective To evaluate the hemostatic effect of selective artery embolization in treatment for traumatic hepatic rupture bleeding.
Methods The clinical data of 63 patients with traumatic hepatic rupture treated in this hospital from Jan. 2004 to Jun. 2011 were analyzed retrospectively. With Seldinger technique, a catheter was introduced into the liver artery via the right femoral artery for angiography. Once the bleeding site was identified, microcatheter was placed into the hemorrhagic vessels to control the bleeding with polyvinyl alcohol or gelatin sponges.
Results The hepatic arteriography was successfully performed in 63 cases, the results showed hepatic left-artery bleeding in 8 cases, hepatic right-artery bleeding in 39 cases, and hepatic left- and right-artery bleeding in 10 cases. Fifty-seven cases received selective arterial embolization and successful hemostasia, including one embolization in 36 cases, two embolizations in 11 cases, and more than two embolizations in 10 cases. Six patients without obvious hemorrhage didn’t receive selective arterial embolization. There was no bleeding again case and no dead case. The hemoglobin and hematocrit returned to normal in one week after embolization. No hemorrhage or other complications happened during follow-up for 0.5 to 1 year.
Conclusion The selective arterial embolization is an effective, safe and minimally invasive method for hemostasia of patients with traumatic hepatic rupture.

关键词: 创伤; 肝脏破裂; 出血; 选择性肝动脉栓塞

Key words: Trauma; Hepatic rupture; Bleeding; Selective hepatic artery embolization

引用本文: 詹世林,陈建雄,陆树桐,霍枫. 选择性出血动脉栓塞治疗创伤性肝脏破裂出血. 中国普外基础与临床杂志, 2012, 19(10): 1098-1101. doi: 复制

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