动脉栓塞治疗血流动力学不稳定的创伤性血胸  

Transcatheter arterial embolization for hemodynamically unstable traumatic hemothorax

作　　者：王刚刚[1] 蒋利强[1] 王云[1] 任葆胜[1] 刘凯[1] 赵进委[1] WANG Ganggang;JIANG Liqiang;WANG Yun;REN Baosheng;LIU Kai;ZHAO Jinwei(Department of Vascular and Interventional Radiology,The Third Affiliated Hospital of Nanjing Medical University(Changzhou Second People's Hospital),Changzhou,Jiangsu 213000,China)

机构地区：[1]南京医科大学第三附属医院(常州市第二人民医院)介入血管科,江苏常州213000

出　　处：《手术电子杂志》2024年第6期24-29,共6页Electronic Journal of Medical Operations

基　　金：常州市“十四五”卫生健康高层次人才培养工程(领军人才)(2022CZLJ026)

摘　　要：目的 探讨动脉栓塞术(TAE)治疗血流动力学不稳定的创伤性血胸的临床应用价值。方法 回顾性分析常州市第二人民医院2015年4月—2023年12月采用TAE治疗的15例血流动力学不稳定的创伤性血胸患者的临床资料。术前患者均接受电子计算机断层扫描(CT)等相关检查,明确诊断并评估伤情。术中对责任动脉进行栓塞,术后随访至患者出院或院内死亡。技术成功:成功插管至出血的责任血管并成功实施栓塞治疗。临床成功:患者治愈出院,本次住院期间无需其他手术干预止血。结果 共纳入15例患者,均先进行胸腔闭式引流,其中14例患者直接行TAE,1例外科止血失败后行TAE。造影表现:所有患者肋间动脉造影均见不同程度的对比剂外渗;其中6例合并假性动脉瘤,1例L1及L2动脉对比剂外渗;2例髂内动脉对比剂外渗。栓塞动脉数目1~7支,平均5支。2例行肋间前动脉栓塞。技术成功率为100%,临床成功率为66.7%。死亡5例,死亡率33.3%,其中1例死于重症颅脑损伤,2例死于多脏器功能衰竭,2例死于弥散性血管内凝血,均无栓塞相关严重并发症。结论 TAE治疗血流动力学不稳定的创伤性血胸具有微创、止血效果确切的优势,为一种安全有效的治疗方法。Objective To explore the clinical value of transcatheter arterial embolization(TAE)in the treatment of hemodynamically unstable traumatic hemothorax.Methods A retrospective analysis was conducted on the clinical data of 15 patients with hemodynamically unstable traumatic hemothorax who underwent TAE between April 2015 and December 2023 in changzhou second people's Hospital.All patients underwent preoperative CT and other related examinations to confirm the diagnosis and assess the injury.During the procedure,the responsible arteries were embolized.Postoperative follow-up continued until the patients were discharged or died in the hospital.Technical success was defined as successful catheterization to the responsible bleeding vessel and successful embolization treatment.Clinical success was defined as discharge after recovery without additional surgical interventions for hemostasis during hospitalization.Results A total of 15 patients were included,all of whom first underwent closed thoracic drainage.Fourteen patients underwent TAE directly,while 1 patient underwent TAE after the failure of surgical hemostasis.Angiography showed varying degrees of contrast extravasation from the intercostal arteries in all patients.Among them,6 cases were complicated with pseudoaneurysms,1 case showed contrast extravasation from the L 1 and L 2 arteries,and 2 cases showed contrast extravasation from the internal iliac artery.The number of embolized arteries ranged from 1 to 7,with an average of 5.Two patients underwent embolization of the anterior intercostal artery.The technical success rate was 100%,and the clinical success rate was 66.7%.There were 5 deaths,resulting in a mortality rate of 33.3%,including 1 death due to severe craniocerebral injury,2 due to multiple organ failure,and 2 due to disseminated intravascular coagulation.No serious embolization-related complications were observed.Conclusion TAE for the treatment of hemodynamically unstable traumatic hemothorax offers the advantages of being minimally invasive and prov

关 键 词：创伤性血胸 胸部创伤 肋骨骨折 肋间动脉 栓塞 

分 类 号：R655[医药卫生—外科学]