肝脏外伤与肝脏病变继发出血的介入治疗价值  

The Value of Interventional Therapy for Hepatic Trauma and Secondary Hemorrhage of Hepatic Lesions

作　　者：刘书林[1] 徐浩铜 Liu Shulin;Xu Haotong(Department of Radiology,The First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China)

机构地区：[1]成都医学院第一附属医院放射科,成都610500

出　　处：《成都医学院学报》2019年第2期207-210,270,共5页Journal of Chengdu Medical College

基　　金：中国博士后科学基金面上资助项目(No:2015M572820)

摘　　要：目的探讨经肝动脉栓塞治疗不同原因致肝破裂出血的临床效果及安全性。方法选取2008至2016年于成都医学院第一附属医院行肝动脉栓塞治疗肝破裂出血的28例患者作为试验组。随机选取同时段单纯行外科手术的肝破裂出血患者21例作为对照组,评估两种术式的临床疗效及安全性。结果试验组28例患者中,肝癌破裂出血21例,肝外伤出血4例,肝血管畸形出血3例。21例肝癌患者中,巨块型14例,结节型5例,弥漫性2例。经肝动脉介入栓塞术后,20例患者即时止血成功,1例肝顶部巨块型肝癌患者于4d后再出血,急诊数字减影血管造影(DSA)发现右膈下动脉供血,予以栓塞后出血停止;4例肝外伤出血患者中,3例采用明胶海绵和弹簧圈栓塞,1例用明胶海绵栓塞,栓塞后血压、脉搏逐渐趋于稳定;3例肝血管畸形出血患者中,肝动脉畸形1例与肝动静脉畸形2例经PVA颗粒及明胶海绵栓塞治疗后,平均随访13个月,疗效确切,未发生严重并发症。对照组21例患者中:肝癌16例,10例肿瘤位于右肝,6例肿瘤位于左肝;肝外伤5例。对照组显效13例,愈后良好5例,疗效较差3例。试验组患者在愈后情况、手术时间、住院时间和并发症方面均优于对照组患者,差异有统计学意义(P<0.05)。结论选择合适的栓塞材料栓塞出血责任血管,对肝癌、外伤肝破裂及肝血管畸形等原因导致的肝出血有确切的疗效。Objective To investigate the clinical efficacy and safety of transcatheter arterial embolization (TAE) in the hepatic rupture hemorrhage caused by different causes. Methods A total of 28 patients with hepatic rupture hemorrhage treated with TAE in The First Affiliated Hospital of Chengdu Medical College from 2008 to 2016 were selected into the experiment group, while the other 21 patients with hepatic rupture hemorrhage treated with surgery over the corresponding period were selected randomly into the control group. The clinical efficacy and safety in both groups were evaluated. Results Among the 28 cases of the experiment group, there were 21 cases with hepatic rupture hemorrhage caused by liver cancer, 4 cases caused liver trauma and 3 cases caused by hepatic vascular malformation. Among the 21 patients with liver cancer, there were 14 cases with massive type, 5 cases with nodular type and 2 cases with diffuse type. The bleeding of 20 liver cancer patients was stopped quickly after TAE, while the bleeding of 1 patient with massive hepatocellular carcinoma at the top of liver reocurred 4 days after TAE. The results of emergency digital subtraction angiography (DSA) revealed the blood was supplied by the right inferior phrenic artery and the bleeding was stopped after embolization. Among the 4 cases with hepatic hemorrhage caused by liver trauma, one case was treated with gelatin sponges and the other 3 cases were embolized with gelatin sponges and spring coils. All the patients' blood pressure and pulse tended to become stable gradually after TAE. Among the 3 cases with hepatic hemorrhage caused hepatic vascular malformation, there were 1 case with hepatic artery malformation and 2 cases with arteriovenous malformation, and they were embolized with PVA granules and gelatin sponges with good clinical efficacy and no serious complications during the average follow-up time of 13 months. Among the 21 cases of the control group, there were 16 cases of liver cancer and 5 cases of liver trauma. Among the 16 cases of li

关 键 词：肝破裂 出血 血管栓塞术 疗效 

分 类 号：R657.3[医药卫生—外科学]