外科术后出血的DSA诊断及介入治疗  

DSA diagnosis and interventional management of postoperative bleeding

作　　者：李玉伟[1] 张富强[1] 李云辉[1] 袁亮[1] 斯光宴[1] 刘莉丽[1] 

机构地区：[1]泸州医学院附属医院介入病房,四川646000

出　　处：《介入放射学杂志》2009年第2期147-149,共3页Journal of Interventional Radiology

摘　　要：目的探讨DSA诊断及介入治疗在外科术后出血的应用价值。方法回顾分析2005年8月-2008年1月经DSA诊断及介入治疗的14例外科术后出血患者的临床资料及疗效,其中胃大部切除术后4例,胰十二指肠切除术后3例,剖宫产术后2例,肾结石取石术后3例,肾血管平滑肌脂肪瘤术后1例,内痔术后1例。结果共发现17处动脉出血,其中胃十二指肠动脉出血2例,胃左动脉出血4例,膈动脉出血1例,胃短动脉出血1例,肠系膜上动脉出血2例,肾动脉出血4例,子宫动脉出血2例,阴部内动脉的肛动脉出血1例。全部病例经DSA明确诊断,其中13例进行栓塞治疗,均一次性栓塞止血成功,1例超选插管失败而再次外科手术止血,止血有效率达92.3%。所有病例均无器官坏死、功能障碍等并发症发生。结论DSA在外科术后出血的诊断及介入治疗上具有定位准确、创伤小、操作时间短、安全、疗效可靠等优点,具有重要的临床应用价值。Objective To discuss the clinical application of DSA and interventional management in diagnosing and treating the bleeding after surgery. Methods The clinical data and the interventional management of 14 patients with DSA-proved postoperative bleeding, encountered during the period of Aug. 2005 - Jan. 2008, were retrospectively analyzed. The surgeries included subtotal gastrectomy （n = 4）, pancreatoduodcnectomy （n = 3）, cesarean section （n = 2）, nephrolithotomy （n = 3）, heminephrectomy （n = 1）, internal hemorrhoidectomy （n = 1）. Results Seventeen arterial bleeding sites were demonstrated, including gastroduodenal （n = 2）, left gastric （n = 4）, phrenic （n = 1）, short gastric （n = 1）, superior mesenteric （n -- 2）, renal （n = 4）, uterine （n = 2） and internal pudendal （n ~ 1）. artery. The diagnosis was confirmed with DSA in all 14 patients, of which embolization was successfully carried out in 13 in one session （92.8%）. The remaining one case had to be operated again to stop the bleeding because of the failure of the superselective catheterization. No serious complications, such as organ necrosis or visceral dysfunction, occurred. Conclusion As a safe, minimally-invasive and effective technique, DSA and interventional management are very helpful in diagnosing and treating the bleeding after surgery. （J Intervent Radiol, 2009, 18： 147-149）

关 键 词：外科术后出血 数字减影 血管造影 治疗学 介入 

分 类 号：R619[医药卫生—外科学]