Wang Zhi-Wei, Xue Hua-Dan, Li Xiao-Guang, Pan Jie, Zhang Xiao-Bo, Jin Zheng-Yu
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China.
Chin Med Sci J. 2016 Mar 20;31(1):43-48. doi: 10.1016/s1001-9294(16)30021-9.
Objective To evaluate the role of multidetector computed tomography-angiography (MDCTA) for management of life-threatening spontaneous retroperitoneal haemorrhage (SRH).Methods A retrospective analysis of the medical records of all SRH patients admitted to our hospital from January 1, 2005 to November 31, 2014 was performed. SRH was defined as unrelated to invasive procedures, surgery, trauma, abdominal tumor or aortic aneurysm. Life-threatening SRH was defined as hemodynamic instability with hypotension. Sixteen cases met the inclusive criteria. Patients' characteristics, clinical presentation, imaging of MDCTA, treatment modalities, morbidity, and follow-up data were analyzed.Results The group of 16 patients included 11 men and 5 women, with a mean age of 51.5±16.4 years. All patients underwent MDCTA scan examinations, and active contrast media (CM) extravasation were found in 9 patients. Angiography was performed for 8 patients in the CM extravasation group. Bleeding vessels were found in 7 patients who underwent successful embolization. One patient in the CM extravasation group did not undergo angiography and died of bleeding. Seven patients without active CM extravasation underwent conservative management. Bleeding was controlled for all these 7 patients, and 1 patient died of multiple organ failure. Fourteen patients survived from SRH were successfully discharged. One patient died of heart failure during follow-up.Conclusion MDCTA was useful in the diagnosis of SRH and proved to be predictive for the outcome of conservative treatment and early intervention.
目的 评估多排螺旋计算机断层血管造影（MDCTA）在危及生命的自发性腹膜后出血（SRH）治疗中的作用。方法 对2005年1月1日至2014年11月31日期间我院收治的所有SRH患者的病历进行回顾性分析。SRH定义为与侵入性操作、手术、创伤、腹部肿瘤或主动脉瘤无关。危及生命的SRH定义为伴有低血压的血流动力学不稳定。16例符合纳入标准。分析患者的特征、临床表现、MDCTA影像学表现、治疗方式、发病率及随访数据。结果 16例患者中男性11例，女性5例，平均年龄51.5±16.4岁。所有患者均接受了MDCTA扫描检查，9例患者发现有活动性造影剂（CM）外渗。CM外渗组8例患者进行了血管造影。7例接受成功栓塞的患者发现了出血血管。CM外渗组1例患者未进行血管造影，死于出血。7例无活动性CM外渗的患者接受了保守治疗。这7例患者出血均得到控制，1例死于多器官功能衰竭。14例SRH存活患者成功出院。1例患者在随访期间死于心力衰竭。结论 MDCTA对SRH的诊断有用，且被证明对保守治疗和早期干预的结果具有预测性。
