经皮肝穿刺胆道引流术后肝动脉出血的介入治疗.doc

经皮肝穿刺胆道引流术后肝动脉出血的 介入治疗 郑加贺迟源王传卓刘兆玉郭启勇 中国医科大学附属盛京医院放射科 R的探讨肝动脉造影及经动脉栓塞在经皮肝穿刺胆道引流术（PTCD）后动脉出 血诊断和治疗中的价值。方法回顾性分析2013年1月2015年7月11例PTCD 术后动脉出血患者临床资料，1例表现为出血性休克，急诊行肝动脉造影;6例拟 行胆道支架置入，撤出引流管后见引流道鲜血涌出伴剧烈腹痛，将引流管送回 原位行肝动脉造影;3例引流管反复引出血性胆汁，1例术后间断黑便且血红蛋白 减低，均经保守治疗无效后行肝动脉造影。结果肝动脉造影表现为假性动脉瘤 4例，肝动脉胆管瘘7例。9例患者责任动脉采用弹簧圈栓塞，2例采用弹簧圈 及明胶海绵栓塞。术后所有患者血红蛋白稳定，出现不同程度转氨酶增高、发热 及腹痛等表现，对症治疗后好转，6例1周后成功行胆道支架置入。术后患者随 访56个月，均无再次胆道出血。结论肝动脉造影及经动脉栓塞损伤小、安全 有效，可作为治疗PTCD术后肝动脉出血的首选方法。 关键词： 肝动脉造影;经动脉栓塞;肝动脉岀血;经皮肝穿刺胆道引流术; 郑加贺（1974-）,男，辽宁海城人，毕业于中国医科大学，医学博 士，副教授，主要从事外周介入治疗工作 郭启勇教授，生导师E-mail :guoqy@sj-hospi-tal. org 2016-12-20 The interventional treatment for bleeding of hepatic artery after percutaneous transhepatic cholangial drainage ZHENG Tiahe CHIYuan WANG Chuanzhuo LlUZhaoyu GUO Qiyong Department of Radiology， Shengjing Hospital of China Medical University; Abstract： Objective To investigate the finding of hepatic angiography and effectiveness of transcatheter arterial embolization ( TAE) for bleeding of hepatic artery after percutaneous transhepatic cholangial drainage (PTCD) . Methods 11 patients were enrolled from January 2013 to July 2015. The clinical manifestations included that hemorrhagic shock ( n = 1)， severe abdominal pain and bleeding along PTCD tract after removing the drainage tube over a wire for implantation of metal stents, the tube was put back and hepatic arteriography was performed immediately ( n = 6), intermittent hemorrhagic bile from the drainage tube ( n = 3) and recurrent melena with decrease of hemoglobin ( n = 1) . Results The angiography demonstrated pscudoancurysm ( n = 4) and hepatic artcrio-biliary fistula (n = 7) . The materials used for TAE included coil ( n = 9) and coil plus gelatin sponge ( n = 2) . In all patients, bleeding was stopped right after TAE. Metal stents were successfully implanted for 6 patients after one week. No sign of recurrent blceding was observed during 5 ~ 16 months following-up. Complications associated with TAE included transient abdominal pain， fever