组织胶栓塞治疗急性消化系统动脉出血的临床应用

Transcatheter arterial embolization with tissue adhesive for acute gastrointestinal arterial hemorrhage

目的 探讨应用组织胶经导管动脉栓塞治疗各种急性消化道动脉出血的可行性与临床疗效.方法 回顾性分析因消化道动脉出血接受组织胶栓塞治疗患者24例,包括上消化道出血14例、下消化道出血10例.栓塞剂为组织胶与碘油混合液.其中4例在外院行弹簧圈、颗粒栓塞治疗无效后应用组织胶栓塞治疗,其余20例均首先应用组织胶进行栓塞.术后严密监测患者病情变化,对技术成功率、临床成功率、再出血率及栓塞相关并发症进行分析.结果 24例患者均成功进行栓塞,21例患者术后出血完全控制,临床成功率87.5％（21/24）.2例患者组织胶栓塞后发生再出血,其中1例行急诊外科手术;1例再次行组织胶栓塞治疗,术后未发生再出血.20例患者术后出现局部轻度腹痛,24 h内均自行缓解.13例存在凝血功能障碍的患者中,1例患者因弥散性血管内凝血于栓塞术后20 h死亡,12例出血均得到有效控制,临床成功率达92.3％（12/13）.组织胶栓塞后所有患者均未出现肠道坏死、异位栓塞等严重并发症.结论 应用组织胶介入栓塞治疗急性消化道动脉出血安全可行、临床疗效满意.

Objective To evaluate the feasibility and efficacy of transcatheter arterial embolization with tissue adhesive for the treatment of acute gastrointestinal arterial hemorrhage.Methods Endovascular embolization performed in 24 patients （15 male and 9 female,aged 28-87,mean age,41 years） with angiographic appearance of contrast extravasion,pseudoaneurysm,enlarged and tortuous vessels was retrospectively analyzed.Upper gastrointestinal hemorrhage was found in 14 patients and lower gastrointestinal hemorrhage in 10 patients.Transcatheter superselective embolization was performed with the mixture of N-butyl cyanocrylate （NBCA） and iodized oil.Among them,4 patients who were not cured by embolization with coils and embolic particles were transferred to our hospital,receiving transcatheter arterial embolization with tissue adhesive.We chose tissue adhesive as the embolic agents of first choice in the remaining 20 patients.The technical and clinical success rate,rebleeding rate and complications were summarized.Results The technical success rate was 100.0％ （24/24）.The bleeding was controlled in 21 patients who had no rebleeding during follow-up period and the clinical success rate was 87.5％ （21/24）.Rebleeding occurred in two patients,one was managed with emergency surgery and the other underwent the second embolization therapy.Mild abdominal pain occurred in 20 patients with spontaneous symptom alleviation within 24 hours after embolization.One patient died of disseminated inravascular coagulation at 20 hours after the procedure.Of 13 cases with coagulation dysfunction,embolization was successful in 12patients （92.3％） without rebleeding.Neither ectopic embolism nor severe complications such as intestinal necrosis was observed.Conclusion Transcatheter superselective embolization with the mixture of NBCA and iodized oil is a safe and effective treatment for acute gastrointestinal arterial hemorrhage.