CAJ | 학술논문

目的：讨论胆道出血的数字减影血管造影表现，经导管超选择性双重栓塞治疗胆道出血的疗效。方法：采用Seldinger's技术，经股动脉置入导管，行选择性肠系膜上动脉、腹腔动脉、肝动脉数字减影血管造影。经导管超选择栓塞出血动脉出血点的远端和近端，栓塞后造影了解栓塞效果。结果：12例胆道出血选择性肝动脉血管造影的表现，8例表现为肝内假性动脉瘤，2例为肝癌并发动脉-门脉瘘，2例肝部分切除术后出现肝内片状造影剂溢出影。2例腹腔动脉造影阴性，而选择性肝动脉血管造影均显示病灶；10例经导管用明胶海绵加弹簧圈或微弹簧圈栓塞治疗1次，出血停止，随访无再出血。2例用明胶海绵栓塞，其中1例栓塞治疗后3周，再次发生出血，用明胶海绵加弹簧圈栓塞出血停止。结论：选择性肝动脉血管造影是诊断胆道出血的关键，超选择性双重栓塞出血动脉的远端和近端是治疗胆道出血安全有效的止血方法，其治疗一次性止血率优于单纯明胶海绵栓塞。
목적：토론담도출혈적수자감영혈관조영표현，경도관초선택성쌍중전새치료담도출혈적료효。방법：채용Seldinger's기술，경고동맥치입도관，행선택성장계막상동맥、복강동맥、간동맥수자감영혈관조영。경도관초선택전새출혈동맥출혈점적원단화근단，전새후조영료해전새효과。결과：12례담도출혈선택성간동맥혈관조영적표현，8례표현위간내가성동맥류，2례위간암병발동맥-문맥루，2례간부분절제술후출현간내편상조영제일출영。2례복강동맥조영음성，이선택성간동맥혈관조영균현시병조；10례경도관용명효해면가탄황권혹미탄황권전새치료1차，출혈정지，수방무재출혈。2례용명효해면전새，기중1례전새치료후3주，재차발생출혈，용명효해면가탄황권전새출혈정지。결론：선택성간동맥혈관조영시진단담도출혈적관건，초선택성쌍중전새출혈동맥적원단화근단시치료담도출혈안전유효적지혈방법，기치료일차성지혈솔우우단순명효해면전새。
Objective:To discuss the DSA features of hemobilia and the efficacy of transcatheter arterial double embolization for hemobilia. Methods: The catheter was introduced into SMA, CA, HA respectively to perform angiography. When the bleeding artery was documented, the proximal and distal area of the bleeding site was embolized by gelfoam and spring coil through catheter. Results: Angiograms of 12 cases of hemobilia showed pseudoaneurysms (n = 8), arterial-portal fistula caused by hepatic cancer( n = 2), and contrast medium leakage from arterial into hepatic parenchyma following partial hepatic resection ( n = 1 ). In 2 cases the celiac axis angiography failed to demonstrate hemorrhage,but this was demonstrated by hepatic angiography. 10 cases embolized by spring coil with gelfoam stopped bleeding and no further bleeding occurred at follow-up. One of two cases with gelfoam embolization recurred hemorrhage three weeks later and then underwent embohzation of spring coil with gelfoam for hemostasis. Conclusion: Selective hepatic angiography is the key to diagnose hemobilia. Transcatheter arterial double embolization of the proximal and distal site of the bleeding vessel is a safe and effective method for hemobilia, efficacy of hemostasis with spring coil and gelfoam is superior to that with gelfoam alone.