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例1.女性,64岁。胰头癌根治术后,间歇性胆道出血,柏油样大便,血压下降。需输血等处理方好转。在第四次出血时急诊手术,术中胆道镜见胆肠吻合口上方左肝管开口处有一糜烂出血病灶,结扎左肝动脉后出血停止。但术后1周再次出血,行数字减影血管造影(DSA),经腹腔动脉造影示左肝动脉有狭窄,左肝动脉及胃左动脉分支有造影剂外溢,胃左动脉和左肝动脉超选择注入明胶海绵及颗粒,再次造影见出血灶血管已闭塞,术后无再出血。
Example 1. Female, 64 years old. After radical treatment of pancreatic head cancer, intermittent biliary tract bleeding, tarry stool, and blood pressure decreased. Need blood transfusion and other treatment side improved. In the fourth bleeding emergency operation, intraoperative biliary microscopy showed a erosive lesion at the left hepatic duct opening above the biliary-enteric anastomosis, and bleeding was stopped after ligation of the left hepatic artery. However, bleeding was performed again at 1 week after operation. Digital subtraction angiography (DSA) was performed. Celiac artery angiography showed left hepatic artery stenosis. Left hepatic artery and left gastric artery branch had contrast agent spillover. The left gastric artery and left hepatic artery were over. The injection of gelatin sponge and granules was selected, and the blood vessels in the hemorrhagic foci were obstructed again after angiography. No rebleeding occurred after the operation.