选择性膀胱动脉栓塞与髂内动脉栓塞治疗重度出血性膀胱炎的效果比较

Selective bladder artery embolization and internal iliac artery embolization for the treatment of severe hemorrhagic cystitis: a comparative study

目的 比较膀胱动脉栓塞与髂内动脉栓塞治疗骨髓移植术后重度出血性膀胱炎（HC）的疗效。方法 收集自2008年3月至2015年5月期间共34例重度HC患者,根据病情采用选择性膀胱动脉栓塞或髂内动脉栓塞控制出血,均采用明胶海绵颗粒栓塞供血动脉。结果 134例患者共采用37次栓塞治疗,双侧髂内动脉栓塞14例（A组）,血尿消失10例,术后于3-14 d（平均5d）止血;血尿明显减少1例,手术满意率71%;双侧膀胱动脉栓塞20例（B组）,血尿消失16例,术后于2-15 d（平均4d）血尿消失。3例术后血尿减少,满意率80%。2A组术后疼痛程度2-8分（平均5分）,B组术后疼痛程度0-5分（平均3分）。栓塞后综合征（尿频、尿急、发热、腹痛等）持续时间：A组3-10 d（平均4.5 d）,B组为2-10 d（平均3.5 d）。结论 1膀胱动脉栓塞和骼内动脉栓塞两者栓塞效果无明显差异。2选择性膀胱动脉栓塞后反应更轻,持续时间更短,应首选膀胱动脉栓塞术。

Objective To compare the clinical effect of selective bladder artery embolization and internal iliac artery embolization for the treatment of severe hemorrhagic cystitis （HC） occurring after bone marrow transplantation. Methods A total of 34 patients with severe HC, who were admitted to authors＇ hospital during the period from May 2015 to March 2008, were collected. According to patient＇s condition, selective bladder artery embolization or internal iliac artery embolization was performed in order to control hemorrhage. The blood supply arteries were obstructed with gelatin sponge in all patients. Results （1） A total of 37 times of embolization procedures were carried out in 34 patients. Embolization of bilateral internal iliac arteries was performed in 14 patients （group A）, among them hematuria disappeared in 10 patients. The hematuria stopped within 3-14 days （mean of 5 days） after the embolization. The hematuria was significantly reduced in one patient. The satisfactory rate of surgery was 71%. Bilateral bladder artery embolization was adopted in 20 patients （group B）, among them hematuria disappeared in 16 patients. The hematuria stopped within 2-15 days （mean of 4 days） after the embolization. The hematuria was obviously reduced in 3 patients. The satisfactory rate was 80%. （2） Postoperative visual analogue scale （VAS） score of group A was 2-8 points （mean of 5 points）, while postoperative VAS score of group B was 0-5 points （mean of 3 points）. The duration of post-embolization syndrome in group A and group B was 3-10 days （mean of 4.5 days） and 2-10 days （mean of 3.5 days） respectively. Conclusion （1） For the treatment of severe hemorrhagic cystitis, the therapeutic effect of selective bladder artery embolization is not significantly different from that of selective internal iliac artery embolization. （2） Compared with the selective internal iliac artery embolization, the postembolization symptoms and duration in selective bladder artery embolization are more mild and short. Therefore, selective bladder artery embolization is the preferred method in clinical practice.