消化道大出血外科术前介入治疗的策略和临床价值

Strategy and clinical significance of interventional management before surgical therapy for massive hemorrhage of gastrointestinal tract

目的探讨消化道大出血外科术前进行介入治疗的临床价值,比较垂体后叶素灌注治疗和栓塞治疗2种介入方法的疗效和复发率。方法1998年6月至2009年4月间,31例消化道大出血患者在我院接受手术治疗并于术前行介入治疗,根据患者造影情况,分别采用经动脉灌注垂体后叶素和经导管栓塞治疗。评价介入治疗的临床疗效和对手术的影响,比较2种不同介入治疗方法的止血率和复发率。计数资料采用Fisher精确概率法,统计软件使用SPSS11.0。结果31例患者顺利完成介入治疗,垂体后叶素灌注组和栓塞组的术后止血率分别为69.2%(9/13)、94.4%(17/18),复发率分别为4/9、23.7%(4/17)。31例患者介入治疗术后均顺利完成外科手术,其中择期手术20例,未出现手术和介入治疗相关严重并发症和死亡患者。结论术前介入治疗能为消化道大出血患者提供的手术机会,使部分急症手术变为择期手术,从而降低了手术风险,值得临床推广。

Objective To discuss the clinical value of interventional management before surgical therapy for massive gastrointestinal hemorrhage,and to compare the clinical efficacy and re-bleeding rate between hypophysin infusion group and embolization group.Methods During the period of June 1998-Apr. 2009,31 patients with massive gastrointestinal hemorrhage in our institution underwent preoperative interventional managements before they received surgical treatment.According to DSA manifestations,the patients underwent transarterial hypophysin infusion or transcatheter embolization as interventional management.The clinical efficacy of interventional procedures and its influence on the surgery were evaluated,and the hemostasis rate and re-bleeding rate were compared the two kind of intervention managements.The numeration data were analyzed with Fisher’s exact test,and the SPSS 11.0 was used as statistical software.Results The interventional managements were successfully performed in all the 31 patients,with a total hemostasis rate of 83.9%（26/31）and a total re-bleeding rate 30.7%（8/26）.The hemostasis rate and re-bleeding rate of hypophysin infusion group and embolization group were 69.2%（9/ 13）,94.4%（17/18）and 44.4%（4/9）,23.7%（4/17）,respectively.All the 31 patients received surgery after interventional therapy,of which selective operation was carried out in 20.Neither surgery-related or intervention-related serious complications nor death occurred.Conclusion Preoperative interventional managements can provide patients with massive gastrointestinal hemorrhage with valuable chance of a successful surgery,enable the physician to take a selective operation to replace an emergency one,as a result,the surgical risk will be greatly reduced.Therefore,it is worth popularizing the preoperative interventional managements in clinical practice.