试验性栓塞治疗上消化道出血的临床疗效分析

Experimental embolization for upper gastrointestinal bleeding:Clinical analysis

目的观察试验性栓塞治疗动脉造影阴性的胃或十二指肠出血的临床疗效。方法 125例经内镜治疗失败的上消化道出血患者常规接受腹部血管造影。对动脉造影阳性的75例患者(阳性组)行出血动脉栓塞。对动脉造影阴性的50例患者(阴性组),根据其临床表现和内镜检查结果,行相应动脉试验性栓塞。栓塞剂均采用明胶海绵颗粒及弹簧圈。结果栓塞技术成功率均为100%。阳性组胃十二指肠动脉栓塞有效率为61.70%(29/47),阴性组为55.88%(19/34),差异无统计学意义(χ2=0.277,P=0.599)。对胃出血患者行胃左动脉栓塞,有效率在阳性组为64.29%(18/28),阴性组为31.25%(5/16),差异有统计学意义(χ2=4.454,P=0.035)。未见胃肠道缺血坏死等严重并发症发生。结论对动脉造影阴性的十二指肠动脉出血患者行试验性栓塞治疗可控制部分出血;而对胃出血行试验性栓塞治疗的临床有效率尚待进一步观察。

Objective To assess the clinical efficacy of experimental embolization for upper gastrointestinal bleeding when bleeding artery could not be identified by angiography. Methods Totally 125 upper gastrointestinal bleeding patients un- derwent abdominal vascular angiography after the failure of therapeutic endoscopy. Embolization of bleeding artery was per- formed in 75 angiographic-positive patients （positive group）. Experimental arterial embolization was performed in 50 angio- graphic-negative patients （negative group） according to clinical manifestations and endoscopy resu]ts. Gelfoam particles and steel coil were used as embolizing agents. Results The technical success rate was 100%. In positive group, the efficiency rate of gastroduodenal artery embolization was 61.70%（29/47）, which was 55.88% （19/34） in negative group （Z2 = 0. 277, P=0. 599）. The efficiency rate of left gastric artery embolization in patients with gastric hemorrhage was 64.29% （18/28） in positive group, which was 31. 25% （5/16） with negative group （x2 =4. 454, P=0. 035）. No severe complica- tion, such as gastrointestinal ischemia or infarction occurred. Conclusion Experimental embolization may be beneficial to patients with duodenal hemorrhage, whereas the efficacy of whieh still need to be explored in patients with gastric hemor- rhage.