【摘要】 目的 探讨经血管内介入治疗腹部外科术后迟发性出血的临床疗效。方法 回顾性分析76例因腹部外科术后迟发性出血行造影检查的患者资料。排除标准为造影阳性且未行栓塞治疗或出血病因为其他专科疾病(泌尿、生殖)。根据治疗策略,患者被分为栓塞组(造影阳性,行栓塞治疗)和未栓塞组(造影阴性,未行栓塞治疗)。比较2组治疗结局和分析再出血相关因素。结果76例患者中53例(70%)造影阳性全部行血管内栓塞治疗。栓塞组的技术成功率和临床成功率分别为98.1%(52/53)和71.7%(38/53)。无1例患者术后出现肠道、肝脏严重缺血坏死等并发症。栓塞组和未栓塞组的再出血率分别为28.3%和52.2%(P=0.046)。多因素分析表明介入术前使用血管收缩药(P=0.022)是再出血的独立危险因素。结论 经血管内介入治疗腹部外科术后迟发性出血是一种安全、有效的方法。介入术前使用血管收缩药增加术后再出血的风险。更多还原

【Abstract】 Objective To evaluate the clinical effect of interventional treatment for delayed hemorrhage in patients after abdominal surgery.Methods Data of 76 patients, undergoing angiography due to delayed postoperative hemorrhage, were analyzed retrospectively.The exclusion criteria included positive angiography without embolization or haemorrhage caused by other causes(urological and reproductive system diseases).Based on endovascular procedures, the patients were divided into embolized group(positive angiography with embolization) and non-embolized group(negative angiography without embolization).The outcomes of treatment were compared between two groups and factors associated with rebleeding were also analyzed.Results Angiograms were positive in 70%(53/76) of patients, and intravascular embolizations were performed.In the embolization group, technical success rate and clinical success rate were 98.1%(52/53) and 71.7%(38/53),respectively.No severe complications, such as gastrointestinal or hepatic ischemic necrosis were observed in all patients.The rebleeding rates were 28.3% and 52.2 % in the embolization group and the non-embolization group, respectively(P=0.046).Multivariate analysis showed that use of vasopressor agents before surgery was an independent risk factor for rebleeding(P=0.022).Conclusion Intravascular interventional therapy is a safe and effective method for delayed hemorrhage after abdominal surgery.Use of vasopressor agents before surgery may increase the risk of postoperative rebleeding.更多还原