医用胶经导管行消化系出血血管栓塞的疗效

Transcatheter arterial embolization with medical adhesive for nonvariceal gastrointestinal bleeding

目的:探讨使用福爱乐医用胶配合超选择插管行血管内栓塞术治疗消化系出血的临床安全性,有效性.方法:回顾性分析2010-10/2013-01内科治疗无效,血管造影明确为消化系血管出血并运用福爱乐医用胶栓塞出血血管的35例患者.其中上消化道出血26例:胃溃疡5例,十二指肠溃疡7例,胃癌4例,胰腺癌1例,胃溃疡缝扎止血术后2例,十二指肠溃疡术后1例,胃大部切除、胃肠吻合术后6例.下消化道出血9例:空肠恶性肿瘤2例,回肠恶性肿瘤1例,直肠癌术后复发2例,结肠癌术后复发2例,大肠息肉2例.所有病例均经微导管超选择插管至出血动脉,在透视监视下经微导管向出血动脉内注入福爱乐医用胶+碘化油混合液(比例为1∶1).比较经导管栓塞治疗前及治疗后24 h患者的血压、心率、血红蛋白.患者术后随访1年,观察栓塞疗效及术后并发症.结果:35例消化系出血的患者中,33例单用福爱乐医用胶栓塞,2例用福爱乐医用胶+弹簧圈栓塞.35例患者术中均成功止血,止血成功率100%.4例患者栓塞术后再发出血,其中1例为胰腺癌患者,术后第1天再发消化系大出血,急性失血性休克抢救无效死亡;1例为胃癌患者14 d后再发出血转外科手术治疗,3 mo后死于多器官功能衰竭;1例为胃多发溃疡患者6 d后再发出血成功予以福爱乐胶+弹簧圈栓塞;1例为胃肠吻合术后患者于栓塞术后26 d再发出血,再次予以福爱乐胶栓塞成功.术后5例患者出现腹痛症状,4例患者自行缓解,1例腹痛进行性加重,转外科治疗.随访期间另有5例恶性肿瘤患者因原发疾病在随访期内死亡但并无再出血情况发生.结论:福爱乐医用胶配合超选择插管栓塞消化道出血血管成功率高,术后再出血并并发症发生率低,疗效确切.

AIM： To assess the clinical utility and safety of transcatheter arterial embolization with Fuaile medical adhesive （FAL） for control of arterial bleeding in the upper or lower gastrointestinal tract. METHODS： Thirty-five patients with arterial bleeding of the gastrointestinal tract who underwent therapeutic transcatheter ernbolization using FAL during the period between October 2010 and June 2013 were retrospectively analyzed. Among the patients with upper gastrointestinal bleeding （n = 26）, 5 had gastric ulcer, 7 had duodenal ulcer, 1 had pancreatic cancer, 4 had gastric cancer, 2 previously underwent su- turing to stop bleeding gastric ulcer, I previously underwent surgery for duodenal ulcer, and 6 previously underwent gastrectomy. Among the patients with lower gastrointestinal bleeding （n = 9）, 2 had jejunal cancer, 1 had ileal cancer, 2 had recurrent rectal cancer, 2 had recurrent colon cancer, and 2 had colorectal polyps. Superselective transcatheter arterial embolization with mixtures of FAL and iodized oil （1：1） was performed when the signs of bleeding was observed by radiography. Patient＇s blood pressure, heart rate, and hemoglobin level were assessed during 24 h before and after embolization. All the patients were followed for 1 year, and clinical effectiveness was evaluated and complications were analyzed. RESULTS： Of 35 patients included, 33 were treated with FAL solely and 2 by FAL with microcoil. The rate of successful hemostasis was 100% （35/35）. Four patients experienced rebleeding, of whom one had multiple ulcers and was retreated with coil and FAL successfully 6 days after the procedure, one who underwent gastrointestinal anastomosis was re-cured with FAL perfectly, and the other two died, one for pancreatic cancer three months after the embolization and one for massive rebleeding caused by pancreatic cancer and failed emergency surgery. Abdominal pain occurred in 5 patients, of whom 4 spontaneously relieved and 1 was referred to surgery for increased abdominal pain. Five pa- tients died for cancer after the embolization during the follow-up and no rebleeding occurred. CONCLUSION： The results suggest that FAL can be a useful alternative embolic agent for the treatment of gastrointestinal bleeding, with a low rebleeding rate and incidence of complications if used properly.