临床肝胆病杂志2024，Vol.40Issue(10)：2070-2074,5.DOI:10.12449/JCH241022
致命性医源性胆道出血的影像学特征和治疗对策
Imaging features and therapeutic strategies for lethal iatrogenic hemobilia
摘要
Abstract
Objective To investigate the imaging features and pathogenesis of lethal iatrogenic hemobilia(LIH)and the value of transarterial intervention in the treatment of LIH.Methods A total of 269 patients with upper gastrointestinal bleeding who were admitted to The First Affiliated Hospital of Nanjing Medical University from August 2009 to July 2023 were enrolled,among whom 24 had a confirmed diagnosis of LIH and received treatment,and a retrospective analysis was performed for the clinical data of these 24 patients,including the iatrogenic causes,angiographic findings,and arterial interventions of LIH.Among the 24 patients,23 received transarterial embolization(TAE)with gelatin sponge particles and coils,and 1 received a covered stent for isolation.The main criteria for assessing treatment outcome included the technical success rate of surgery,procedure-related complications,and long-term clinical follow-up.Results Among the 24 patients with LIH,12 had LIH caused by interventional procedures,and 12 had LIH caused by hepatobiliary and pancreatic surgery.The main clinical manifestations included a significant reduction in blood pressure or a persistent reduction in hemoglobin in 13 patients and upper gastrointestinal bleeding in 18 patients.Among the 24 patients,2 developed symptoms during surgery,4 developed symptoms within 24 hours,and 18 developed symptoms after 24 hours.Angiography showed a positive bleeding rate of 100%(24/24),and imaging findings included pseudoaneurysms in 15 patients,hepatic artery truncation in 3 patients,extravasation of contrast medium in 5 patients,and hepatic arteriobiliary fistula in 3 patients.Among the 24 patients,23 received TAE and 1 received stent implantation.Successful hemostasis was achieved for 23 patients,with a technical success rate of 95.8%(23/24).Four patients developed hepatic necrosis and abscess after TAE,and there was no rebleeding or recurrence after hemostatic treatment.Conclusion Various iatrogenic injuries may result in LIH with diverse clinical and imaging findings,and integrated diagnostic imaging combined with transarterial intervention is the best effective life-saving measure for LIH.关键词
胆道疾病/胆道出血/胆道外科手术/诊断显像Key words
Biliary Tract Diseases/Hemobilia/Biliary Tract Surgical Procedures/Diagnostic Imaging引用本文复制引用
王晨,王敏,张科,张金星,刘莉,范志宁..致命性医源性胆道出血的影像学特征和治疗对策[J].临床肝胆病杂志,2024,40(10):2070-2074,5.基金项目
国家自然科学基金(82000621) National Natural Science Foundation of China(82000621) （82000621）
