髂内动脉栓塞治疗骨髓移植后出血性膀胱炎的评价

The role of bilateral internal iliac arterial embolization in the treatment of hemorrhagic cystitis after bone marrow transplantation

目的探讨双侧髂内动脉栓塞在骨髓移植后出血性膀胱炎(HC)治疗中的作用。方法28例HC中7例经内科保守治疗无效的患者接受了双侧髂内动脉栓塞。其中包括慢性粒细胞白血病3例,急性粒细胞白血病2例,急性淋巴细胞白血病和急性粒-单核细胞白血病各1例。所有患者均采用明胶海绵颗粒栓塞双侧髂内动脉脏支。结果7例患者共进行了9次栓塞。4例次患者肉眼血尿消失,出血停止时间2～10d(平均6d),随访期间未出血(12～82d);3例次血尿减少;2例次无效。未见明显与栓塞治疗直接相关的并发症。结论采用双侧髂内动脉栓塞治疗骨髓移植后重度出血性膀胱炎,栓塞效果好、不良反应小,是一行之有效的方法。

Objective To evaluate the usefulness of bilateral internal iliac arterial embolization in the treatment of hemorrhagic cystitis after bone marrow transplantation. Methods Among 28 patients with hemorrhagic cystitis, 7 patients experienced bilateral internal iliac artery embolization because of serious hemorrhage that couldn＇t be controlled by conservative treatments, including CML （n = 3） , AM L （n = 2） , ALL （n = 1 ）,acute myelomonocytic leukemia（M4, n = 1 ）. Embolization of the target vessels was performed by using gelfoam particleas for bilateral internal iliac arterial visceral branches. Results Gross hematuria disappeared in 4 cases after embolization by gelfoam particles. The time of bleeding controlled continued 2-10 d（mean 6 d）. No rebleeding was observed in all of the cases during the 12 - 82 days follow up.Gross hematuria markedly reduced in another 3 cases after embolization. But failure occurred in other two patients. No definite complication related to the procedure was noted. Conclusion Bilateral internal iliac arterial embolization is an effective, less invasive, and safe method for serious hemorrhagic cystitis after bone marrow transplantation. （J Intervent Radiol, 2006, 15 ： 267-269）