α-氰基丙烯酸正丁酯超选择动脉栓塞治疗血管发育不良性下消化道出血7例

Super-selective arterial embolization with N-butyl cyanonacrylate for lower gastrointestinal bleeding due to angiodysplasia:report of seven cases

目的研究α-氰基丙烯酸正丁酯（NBCA）胶超选择动脉栓塞治疗血管发育不良（AD）所致下消化道出血的临床安全有效性，评价其远期效果。方法回顾性分析2013年9月至2015年3月采用NBCA胶超选择动脉栓塞治疗的7例AD所致下消化道出血患者的临床资料、栓塞技术成功率、临床有效性及远期随访结果。结果7例患者人院前有6—36个月反复便血、失血性贫血、多次输血史，栓塞术前血红蛋白最低38～70g/L，平均（56．8±12．4）g／L；AD部位在空肠3例，回肠1例，升结肠1例，横结肠肝曲1例，降结肠1例。6例患者1次栓塞成功，1例横结肠血管畸形患者因2支直动脉参与供血．分2次超选择插管栓塞成功。栓塞使用NBCA胶与超液化碘油按1：2—1：3比例混合．用量为0．2～0．8m1．平均（0．48±0．19）ml，技术成功率为100％。栓塞术后所有患者无肠壁缺血事件发生，无其它介入相关并发症；术后l～3d出院，便血消失。1例慢性。肾衰竭患者术后20d再发出血，临床有效性为85．7％；6例术后随访追踪2～19个月（中位期10．5个月），出血症状消失，无再出血，无器官坏死并发症，远期止血率为100％。结论NBCA胶超选择动脉栓塞治疗AD所致下消化道出血安全有效，可取得较好的中远期疗效。

Objective To discuss the effectiveness and safety of super-selective transcatheter embo - lization with N-butyl cyanoacrylate （NBCA） in treating lower gastrointestinal bleeding caused by angiodys- plasia, and to evaluate its long-term effect. Methods The clinical data of 7 patients with lower gastrointestinal bleeding caused by angiodysplasia, who were treated with super- selective transcatheter embolization with NBCA during the period from September 2013 to March 2015 at authors＇ hospital, were retrospectively analyzed. The success rate of embolization technique, the clinical effectiveness and the long-term follow-up results were evaluated. Results Within 6-36 months before admission, all the 7 patients had repeated hematochezia and hemorrhagic anemia, and received several times of blood transfusion. Preoperative hemoglobin was low to （38-70） g/L, with a mean of （56.8±12.4） g/L. The lesions of angiodysplasia were located at jejunum （n=3）, ileum （n=1）, ascending colon （n=l）, hepatic flexure of transverse colon （n=1） and descending colon （n=1）. Successful embolization with single manipulation was achieved in 6 patients, and 2 times of super-selective catheterization had to be carried out in the remaining patient as this patient had vascular malformation of transverse colon, the lesion having blood supply from two straight arteries. Embolization was performed using NBCA glue and ultra liquefied iodine oil by 1 ： 2 to 1 ： 3 mixing ratio with the used dosage of 0.2-0.8 ml （mean of 0.48-20.19 ml）. The technical success rate was 100%. After embolization nobowel wall ischemia event or other intervention-related complications occurred. The patients were discharged 1-3 days after the treatment, and the hematochezia disappeared. Recurrent bleeding at 20 days after the treatment was seen in one patient with chronic renal failure. The clinical effectiveness was 85.7%. Six patients were followed up for 2-19 months （median 10.5 months）, the bleeding symptoms disappeared, no recurrent bleeding or complications of organ necrosis were observed, and the long-term hemostasis rate was 100%. Conclusion For the treatment of lower gastrointestinal bleeding caused by angiodysplasia, super-selective transcatheter embolization with NBCA is safe and effective, and satisfactory mid-to-long-term effect can be obtained.