胃肠道动脉性大出血的急诊介入栓塞治疗

Emergency interventional embolization for acute life-threatening massive bleeding in gastrointestinal tract

目的探讨危及生命的胃肠道动脉性大出血的急诊造影与栓塞治疗的价值。方法 2006年1月至2010年12月收治胃肠道动脉性大出血患者48例,急诊行经导管动脉血管栓塞治疗,将导管超选择至出血部位,用聚乙烯醇颗粒、明胶海绵或弹簧圈栓塞。结果 48例能确定出血部位,47例成功栓塞出血动脉,1例未行栓塞治疗。4例栓塞后仍有大量出血,采用手术治疗。术后随访6～12个月,总有效率为90%(43/48),无异位栓塞及肠管坏死等严重并发症出现。结论经导管动脉血管栓塞是治疗胃肠道动脉性大出血的一种安全、有效的手段。正确选择栓塞的靶血管和合适的栓塞剂和用量是成功的关键。

Objective To evaluate emergency digital subtraction angiography （DSA） and transcatheter arterial embolization （TAE） in treating acute life-threatening massive bleeding in gastrointestinal tract. Methods During the period from January 2006 to December 2010 a total of 48 patients （35 males and 13 females） with acute gastrointestinal massive bleeding were admitted to authors＇ hospital. Emergency TAE was carried out in all patients. Superselective catheterization was employed, and the catheter was placed in the bleeding site, which was followed by TAE using polyvinyl alcohol particles （PVA）, Gelfoam or steel coils as embolic agents. The clinical results were analyzed. Results DSA correctly localized the bleeding site in all 48 patients. The bleeding arteries were successfully obstructed in 47 patients, in the remaining one patient TAE was not adopted. After embolization procedures the massive hemorrhage still remained in 4 cases, and the surgery had to be carries out in them. All the patients were followed up for 6 - 12 months. The total effective rate was 90% （43/48）. Neither mis-embolization nor severe complications such as intestinal necrosis occurred. Conclusion Transcatheter arterial embolization is a safe and effective procedure for massive arterial hemorrhage in gastrointestinal tract. Proper selection of the target artery and suitable use of the embolization agents are the key points.