超选择性动脉造影并栓塞术诊治空回肠出血性疾病

Highly Selective Angiography and Transarterial Embolization for Jejunal and Ileal Hemorrhage

目的探讨经皮肠系膜上动脉造影并选择性栓塞术治疗空回肠急慢性出血的可行性.方法对2001年12月～2004年12月经皮肠系膜上动脉造影诊断为急慢性空回肠出血的9例患者,均予超选择性微导管靶血管插管注入明胶海绵颗粒栓塞止血,再造影复查确认止血成功. 结果 9例患者中,空肠壁血管畸形4例,回盲部溃疡并出血3例,7例动脉血管栓塞即时止血成功;2例空肠间质瘤患者予栓塞止血后择期行手术切除,均痊愈出院.平均随访1.8年(6个月～3年),未再出血,无肠管坏死、穿孔及血管损伤等严重并发症发生. 结论空回肠出血部位、性质难以确定,出血量大而时间较久的患者内科疗法效果不理想,剖腹探查有较大的盲目性;经皮肠系膜上动脉超选择性动脉造影并栓塞止血,创伤小、并发症少,可同时进行诊断、治疗,具有其独特的优越性,值得推广.

Objective To evaluate the percutaneous selec ti ve superior mesenteric artery angiography and transarterial embolization for jej unal and ileal hemorrhage. Methods During December 2001 to December 2004, 9 cases of acute and chronic jejunal and ileal hemorrhage (4 c ases of jejunal luminal vascular malformation, 2 cases of jejunal interstitialom a, 3 cases of ileaolic bleeding ulcer) underwent percutaneous superior mesenteri c arterial angiography and highly selective transarterial embolization with gela tin granule. Results Hemostasis were achieved in 7 cases , the rest 2 cases underwent surgery after hemostasis due to jejunal interstitia loma. All patients recovered smoothly. With 6 months to 3 years follow-up there was no rebleeding, intestinal necrosis, perforation, or vascular injury. Conclusions Percutaneous superior mensenteric arterial highly selective angiograply and embolization is recommendable for its minimal invasion and low risk.