CAJ | 학술논문

目的探讨介入疗法治疗经皮肝穿刺胆管引流术(PTCD)后胆道大出血的临床应用价值.方法回顾性分析2008年3月至2015年1月621例因胆道梗阻行PTCD,共发生术后胆道大出血8例(1.29%),7例患者首选经选择性血管造影及引流管造影,证实责任血管后行介入治疗.1例先行手术探查,术后再发大出血,予血管造影检查证实假性动脉瘤后行介入治疗.结果 6例患者经造影证实为医源性血管损伤,其中2例为动脉胆管瘘,3例为假性动脉瘤,1例为门静脉胆管瘘.2例动脉胆管瘘及3例假性动脉瘤患者予栓塞责任血管近端、远端后治愈,门静脉胆管瘘患者经保守治疗后死亡.剩余2例为胆管癌栓松动后自发出血,经肝动脉栓塞后止血.结论血管介入治疗为胆道大出血的首选治疗方法,具有安全性高、创伤小、疗效确切的优势.
목적 탐토개입요법치료경피간천자담관인류술(PTCD)후담도대출혈적림상응용개치.방법 회고성분석2008년3월지2015년1월621례인담도경조행PTCD,공발생술후담도대출혈8례(1.29%),7례환자수선경선택성혈관조영급인류관조영,증실책임혈관후행개입치료.1례선행수술탐사,술후재발대출혈,여혈관조영검사증실가성동맥류후행개입치료.결과 6례환자경조영증실위의원성혈관손상,기중2례위동맥담관루,3례위가성동맥류,1례위문정맥담관루.2례동맥담관루급3례가성동맥류환자여전새책임혈관근단、원단후치유,문정맥담관루환자경보수치료후사망.잉여2례위담관암전송동후자발출혈,경간동맥전새후지혈.결론 혈관개입치료위담도대출혈적수선치료방법,구유안전성고、창상소、료효학절적우세.
Objective To investigate the effect of interventional therapy in the treatment of he-mobilia after percutaneous transhepatic cholangial drainage(PTCD). Methods Six hundred and twenty-one patients with PTCD from March 2008 to January 2015 were reviewed. Eight patients (1.29%) were identified with severe hemobilia, 7 of whom underwent angiography or drainage tube radiography first, then the responsible blood vessels were detected and treated interventionally. One patient was given the emergency exploratory operation and severe hemorrhage occurred, finally undergoing interventional thera-py to stop the severe hemorrhage. Results Six patients had surgical iatrogenic injury, including hepatic artery-bile duct fistulas in two patients, hepatic artery pseudoaneurysm in three patients, portal vein-bile duct fistula in one patient. Two patients with hepatic artery-bile duct fistulas and 3 with hepatic artery pseudoaneurysms underwent superselective transcatheter arterial embolization of the distal and proximal criminal artery. One portal vein-bile duct fistula patient died after the conservative treatment. Two patients with tumor thrombi in the bile duct had hemorrhage and underwent interventional therapy. Conclusion Superselective hepatic artery embolization is simple, safe and reliable in the treatment of hemobilia after PTCD .