口腔、咽喉及颈部急性医源性大出血：动脉造影与栓塞控制  

Acute iatrogenic massive hemorrhage from oral cavity, throat and neck: its arterial angiography and control with transcatheter embolization

作　　者：曾晓华[1] 刘忠[1] 邱怀明[1] 赵林[1] 袁远[1] 易翠容[1] 

机构地区：[1]武汉广州军区武汉总医院放射科,430070

出　　处：《介入放射学杂志》2014年第2期111-114,共4页Journal of Interventional Radiology

摘　　要：目的探讨经导管栓塞术在口腔、鼻咽及颌颈部急性医源性大出血的临床应用以及造影和栓塞技巧。方法 2000年8月—2013年4月对口腔、咽喉及颈部病变在行局部检查、局部治疗或外科术后的急性医源性出血、常规治疗方法未能控制出血的10例患者,以Seldinger技术行一侧股动脉穿刺插管,先行两侧颈外动脉主干造影,继行颈外动脉分支超选择性插管造影并栓塞。结果动脉造影均发现病变局部动脉小支破损、对比剂外溢,对10例共16支破损动脉分支进行栓塞,所有患者均一次栓塞成功止血。结论对于口腔、咽喉及颈部急性医源性大出血,颈外动脉造影可明确出血原因,以明胶海绵颗粒或联合微弹簧圈栓塞可彻底控制出血。Objective To explore the clinical application of transcatheter embolization in treating acute iatrogenic massive hemorrhage from oral cavity, throat and neck, and to discuss the technique and skill of angiography and embolization. Methods During the period from Aug. 2008 to Apr. 2013 at the hospital, ten patients developed acute iatrogenic massive hemorrhage after the examination, treatment or surgery of oral cavity, throat or neck. As conventional management failed to stop the bleeding, bilateral external carotid angiography was carried out through catheterization of unilateral femoral artery with Seldinger technique, which was followed by super-selective catheterization with subsequent angiography and embolization therapy using Gelfoam and micro-spring coils. The results were analyzed. Results The causes of iatrogenic massive hemorrhage included pharyngoscopy （n = 3）, surgery of laryngocarcinoma, epiglottis cancer, tonsilla cancer and thyroid cancer （n = 6） and tooth extraction （n = 1）. The abnormal vessel rupture and leakage of contrast agent were confirmed on angiography. Successful embolization and instant hemostasis with single procedure was achieved in all patients. Conclusion For acute iatrogenic massive hemorrhage from oral cavity, throat and neck, external carotid angiography can clearly demonstrate the bleeding site, and embolization with Gelfoam and micro-spring coils can effectively control the bleeding.（J Intervent Radiol, 2014, 23：111-114）

关 键 词：出血 造影 栓塞 

分 类 号：R605.972[医药卫生—急诊医学]