【摘要】 目的 评价介入治疗肝动脉假性动脉瘤(PsAn)致胆道出血的安全性、可行性。方法 回顾性总结、分析在本科接受介入治疗的28例肝动脉PsAn致胆道出血患者的临床资料。患者前期均经内科对症处理,疗效差,转行介入治疗;血管造影明确PsAn形态、位置、大小,进一步行超选择栓塞。术后对症处理,通畅胆道引流,随访1～36个月。患者死亡为随访终点。结果 28例患者诊断肝动脉PsAn明确,胆道出血通过介入手术均及时得到纠正。术中共应用弹簧圈110枚,无介入手术相关并发症发生。1例肝门部胆管癌于术后4周死于感染及肝功能衰竭,2例胆总管癌患者分别于介入术后11.5月、14.2月死于肿瘤进展,2例胃癌患者分别于术后4月、6.5月死于肿瘤进展,1例胆总管结石腹腔镜术后患者于介入术后5月死于并发症冠心病,其他患者至今恢复良好。结论 介入治疗肝动脉PsAn致胆道出血疗效确切,技术微创、安全、可行,值得临床推广应用。更多还原

【Abstract】 Objective To investigate the safety and feasibility of the interventional therapy on hemobilia induced by hepatic artery pseudoaneurysm(PsAn).Methods The clinical data of 28 patients with hemobilia in our department was analyzed retrospectively.All the patients were firstly treated with internal medicine,and then treated by interventional therapy.The angiography clearly displayed the shape,size and location of the PsAn,and superselective embolism was performed during the operation.The symptomatic treatment and the bile duct drainage were performed after operation.Postoperative follow-up time was 1-36 months,and the follow-up endpoint was the death of patient.Results 28 patients were diagnosed as hepatic artery PsAn.The interventional embolization therapy on hemobilia was completely effective.A total of 110 spring coils were applicated in the study,there was no complication related to interventional therapy.One patient with hilar cholangiocarcinoma was dead due to infection and liver failure after four weeks of operation.Two patients with choledochal carcinoma died of tumor progression after 11.5 and 14.2 months of interventional therapy,respectively.In addition,2 patients with gastric carcinoma died of tumor progression after 4 and 6.5 months of operation,respectively,and 1 patient with common bile duct stones who underwent laparoscopic surgery died of complications of coronary heart disease after 5 months of interventional therapy.The other patients all had satisfactory therapeutic effect and recovered well.Conclusion The interventional therapy has definite therapeutic effect on hemobilia induced by hepatic artery PsAn.The technique is worthy of popularized clinically due to its features of simplicity,safety and reliablity.更多还原