Routh W D, Tatum C M, Lawdahl R B, Rösch J, Keller F S
Department of Diagnostic Radiology, University of Alabama, School of Medicine, Birmingham 35233.
Radiology. 1990 Mar;174(3 Pt 2):945-9. doi: 10.1148/radiology.174.3.174-3-945.
Diagnostic angiography performed to search for a source of hemorrhage in three patients with percutaneous transhepatic biliary catheters and one patient with a percutaneous nephrostomy catheter was initially unrewarding when performed with the drainage catheter in place. In each patient, removal of the drainage catheter resulted in severe pulsatile hemorrhage from the parenchymal tract and allowed angiographic localization of the bleeding site. Temporary control of the hemorrhage was then obtained by inflating an angioplasty balloon within the tract. Transcatheter embolotherapy provided definitive control of bleeding in three patients. When initial angiographic evaluation for bleeding in patients with percutaneous biliary and nephrostomy catheters fails to depict a source, the study should be repeated immediately after removal of the drainage catheter. Because hemorrhage can be severe once tamponade is relieved, the drainage catheter should be withdrawn over a guide wire so that a tamponading catheter can be rapidly reinserted to control hemorrhage until more definitive therapy is undertaken.
对3例经皮经肝胆管导管置入患者和1例经皮肾造瘘导管置入患者进行诊断性血管造影以寻找出血源，最初在引流导管在位时进行造影未取得结果。在每例患者中，拔除引流导管均导致实质通道出现严重搏动性出血，并使出血部位得以血管造影定位。然后通过在通道内充盈血管成形球囊实现了出血的临时控制。经导管栓塞治疗为3例患者提供了确定性的出血控制。当对经皮胆管和肾造瘘导管患者进行的初始出血血管造影评估未能显示出血源时，应在拔除引流导管后立即重复该项检查。由于一旦解除压迫出血可能会很严重，引流导管应在导丝引导下拔除，以便能迅速重新插入压迫导管以控制出血，直至采取更确切的治疗措施。
