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目的 观察血管造影和肝动脉栓塞术对胆道术后胆道出血的诊断和治疗价值。方法 9例在胆道手术后 7天到 3个月出现上消化道出血。所有患者行急诊肝动脉造影并采用明胶海绵和微钢圈进行肝动脉栓塞治疗。结果 肝动脉造影检查可见肝动脉假性动脉瘤 3例 ;肝动脉弥漫性出血 3例 ;右肝动脉胆道瘘 2例和肝动脉小肠瘘 1例。通过肝动脉栓塞控制胆道出血 7例 ,其中 1例再出血。 7例患者随访其中 3例死于多功能脏器衰竭。 2例因技术原因无法止血 ,数天后死亡。结论 胆道手术后出现上消化道出血如怀疑是胆道出血 ,应首先采用肝动脉血管造影检查 ,同时尽可能早地采用选择性肝动脉栓塞术治疗胆道出血 ,可获得较好的临床效果。
Objective To observe the value of angiography and hepatic artery embolization in the diagnosis and treatment of biliary tract hemorrhage after biliary tract surgery. Methods Nine patients had upper gastrointestinal bleeding 7 days to 3 months after biliary tract surgery. All patients underwent emergency hepatic arteriography and hepatic artery embolization with gelatin sponge and micro-steel ring. Results Hepatic artery angiography showed that there were 3 cases of pseudoaneurysm of hepatic artery, 3 cases of diffuse hemorrhage of hepatic artery, 2 cases of biliary fistula of right hepatic artery and 1 case of small intestinal fistula of hepatic artery. Hepatic artery embolization in 7 cases of biliary hemorrhage, of which 1 case of rebleeding. Three of the seven patients were followed up and died of multifunctional organ failure. 2 cases due to technical reasons can not stop bleeding, died a few days later. Conclusion If upper gastrointestinal bleeding occurs after biliary surgery, if it is suspected to be biliary bleeding, hepatic arteriography should be used first. At the same time, selective hepatic artery embolization should be used as early as possible to treat biliary tract hemorrhage and obtain better clinical results.