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1、經(jīng)皮肝穿刺膽道引流術(shù)后肝動脈出血的介入治療鄭加賀遲源王傳卓劉兆玉郭啟勇中國醫(yī)科大學(xué)附屬盛京醫(yī)院放射科R的探討肝動脈造影及經(jīng)動脈栓塞在經(jīng)皮肝穿刺膽道引流術(shù)（PTCD）后動脈出血診斷和治療中的價值。方法回顧性分析2013年1月2015年7月11例PTCD術(shù)后動脈出血患者臨床資料，1例表現(xiàn)為出血性休克，急診行肝動脈造影;6例擬行膽道支架置入，撤出引流管后見引流道鮮血涌出伴劇烈腹痛，將引流管送回原位行肝動脈造影;3例引流管反復(fù)引出血性膽汁，1例術(shù)后間斷黑便且血紅蛋白減低，均經(jīng)保守治療無效后行肝動脈造影。結(jié)果肝動脈造影表現(xiàn)為假性動脈瘤4例，肝動脈膽管瘺7
2、例。9例患者責(zé)任動脈采用彈簧圈栓塞，2例采用彈簧圈及明膠海綿栓塞。術(shù)后所有患者血紅蛋白穩(wěn)定，出現(xiàn)不同程度轉(zhuǎn)氨酶增高、發(fā)熱及腹痛等表現(xiàn)，對癥治療后好轉(zhuǎn)，6例1周后成功行膽道支架置入。術(shù)后患者隨訪5'6個月，均無再次膽道出血。結(jié)論肝動脈造影及經(jīng)動脈栓塞損傷小、安全有效，可作為治療PTCD術(shù)后肝動脈出血的首選方法。關(guān)鍵詞：肝動脈造影;經(jīng)動脈栓塞;肝動脈岀血;經(jīng)皮肝穿刺膽道引流術(shù);鄭加賀（1974-）,男，遼寧海城人，畢業(yè)于中國醫(yī)科大學(xué)，醫(yī)學(xué)博士，副教授，主要從事外周介入治療工作郭啟勇教授，生導(dǎo)師E-mail:guoqy@sj-hospi-tal.or
3、g2016-12-20TheinterventionaltreatmentforbleedingofhepaticarteryafterpercutaneoustranshepaticcholangialdrainageZHENGTiaheCHIYuanWANGChuanzhuoLlUZhaoyuGUOQiyongDepartmentofRadiology，ShengjingHospitalofChinaMedicalUniversity;Abstract：ObjectiveToinvestigatethefindingofhepaticang
4、iographyandeffectivenessoftranscatheterarterialembolization(TAE)forbleedingofhepaticarteryafterpercutaneoustranshepaticcholangialdrainage(PTCD).Methods11patientswereenrolledfromJanuary2013toJuly2015.Theclinicalmanifestationsincludedthathemorrhagicshock(n=1)，severeabdominalpa
5、inandbleedingalongPTCDtractafterremovingthedrainagetubeoverawireforimplantationofmetalstents,thetubewasputbackandhepaticarteriographywasperformedimmediately(n=6),intermittenthemorrhagicbilefromthedrainagetube(n=3)andrecurrentmelenawithdecreaseofhemoglobin(n=1).ResultsTheangi
6、ographydemonstratedpscudoancurysm(n=4)andhepaticartcrio-biliaryfistula(n=7).ThematerialsusedforTAEincludedcoil(n=9)andcoilplusgelatinsponge(n=2).Inallpatients,bleedingwasstoppedrightafterTAE.Metalstentsweresuccessfullyimplantedfor6patientsafteroneweek.Nosignofrecurrentblcedi
7、ngwasobservedduring5~16monthsfollowing-up.ComplicationsassociatedwithTAEincludedtransientabdominalpain，feverandelevationofliveraminotransferases,whichcouldbealleviatedbysymptomatictreatment.ConclusionHepaticangiographyandTAEareminimallyinvasive,safeandeffectiveapproach,which
8、canbeperformedfirstlyforthediagnosisandtreatmentofarterialbleedingafterPTCD
