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肝动脉瘤破裂是严重危及患者生命的急症,过去治疗主要依靠外科手术。本文报告肝动脉瘤破裂性胆道出血2例,均经血管造影诊断及结扎右肝动脉止血。其中例2经右肝动脉结扎后,出血止,但术后1周反复出血,又行经导管栓塞治疗,术后出血停止。梗塞后造影显示动脉瘤闭塞消失。文中讨论了肝动脉瘤破裂性胆道出血的病因、临床表现、栓塞前注意事项及栓塞物选择等问题。提出诊断本病的唯一方法是选择性肝动脉造影,治疗采用动脉导管栓塞治疗,其优点是:在动脉造影诊断后即可进行栓塞治疗,操作简单、安全、可靠。如再发生出血,可重复栓塞,因而可避免急诊外科手术,故应为治疗本症的首选方法。
The rupture of hepatic aneurysms is an emergency that seriously endangers the patient’s life. In the past, treatment mainly relied on surgery. This article reports two cases of ruptured biliary hemobilia of hepatic aneurysms. All patients were diagnosed by angiography and the right hepatic artery was ligated to stop bleeding. Among them, after the right hepatic artery was ligated in Example 2, the hemorrhage was stopped, but bleeding was repeated 1 week after the operation, and transcatheter embolization was performed again. Postoperative bleeding stopped. Post-infarct angiography showed that the occlusion of the aneurysm disappeared. The etiology, clinical manifestations, precautions before embolization, and choice of embolus were discussed in this article. The only way to diagnose the disease is to use selective hepatic arteriography to treat patients with arterial catheter embolization. The advantage is that embolization can be performed after diagnosis of arteriography. The operation is simple, safe, and reliable. If bleeding occurs again, embolism can be repeated, so emergency surgery can be avoided. It should be the preferred method for treating this disease.