腹部实质脉石器损伤大出血的介入超选择栓塞治疗.docVIP

腹部实质脏器损伤大出血介入超选择栓塞治疗 Interventional embolization for the treatment of abdominalparenchymal visceral injury hemorrhage 何泽清 刘国庆 汪明全 罗江平 刘兴华 He Zeqing, Liu Guoqing, Wang Mingquan, Luo Jiangping, Liu Xinghua 重庆三峡中心医院CT、MR科（中国 404000） Department of CT and MRI, Chongqing Three Gorges Central Hospital（China 404000) 中图分类号：R816.5 文献标识码：A 文章编号：1818－0086（2011）05 摘要：目的 探讨腹部实质脏器损伤大出血介入超选择栓塞治疗方法和临床疗效分析。方法 回顾性分析总结介入超选择栓塞治疗43例腹部实质脏器损伤大出血患者，均有明确外伤史，其中脾脏挫裂伤16例，肾脏挫裂伤19例，肝脏挫裂伤5例，脾肾合并伤3例， 18例患者有创伤失血性休克。栓塞材料：明胶海绵颗粒(1mm×1mm、2mm×2mm)及弹簧钢圈（美国Ｃook公司，直径3～5mm）。所有病例先行该脏器的动脉血管造影。结果 41例患者介入栓塞后出血立即停止，经输血扩容后血压和血红蛋白回升，2例肾挫裂伤栓塞术后仍可见淡红色肉眼血尿，经静脉立止血治疗，2天后出血停止，血尿消失。23例半年后随访，肝肾功能实验室检查正常。结论 对各种原因所致闭合性腹部实质脏器损伤大出血患者，行急诊动脉造影和超选择栓塞治疗，具有明确出血部位，止血迅速，疗效肯定，并发症少的优点，值得临床推广应用。 关键词：腹部实质器官；大出血；介入栓塞 Abstact:objective To explore the method of interventional embolization for the treatment of abdominal parenchymal visceral injury bleeding and analyze the clinical effect. Methods Interventional embolization was performed in 43 cases of abdominal parenchymal visceral injury bleeding, each cases had definite injury history. Among the cases, 16 cases were spleen injury, 19 cases were renal injury, 5 cases were hepatic injury, 3 cases were injury combined spleen and kidney. 18 cases had traumatic hemorrhagic shock. Embolization materials: gelatin sponge particles (size: 1mm×1mm、2mm×2mm), steel coils (American COOK Company, diameter: 3 ~ 5mm). Results 41 cases stopped bleeding after embolization, the level of blood pressure and hemoglobin upswinged after expansion of blood volume. 2 cases of renal injury had visible blood in the urine after embolization. The bleeding stopped after hemostasis therapy. 23 cases were followed up 6 months, the function of liver and kidney was normal. Conclusion Arteriography and interventional embolization for the treatment of abdominal parenchymal visceral injury hemorrhage has the following advantages: definite the location of bleeding, stop bleeding rapidly, treat effectively, has l