介入栓塞治疗对急性非静脉曲张性上消化道出血的疗效评价

The efficacy evaluation of interventional embolization in the treatment of acute non-variceal upper gastrointestinal bleeding

目的:探讨介入栓塞治疗急性非静脉曲张性上消化道出血的疗效。方法:收集2016年1月~2016年12月海南医学院第一附属医院对18例内镜下止血失败或经内镜医生认定无法耐受内镜下止血的非静脉曲张性上消化道出血的患者,急诊行上消化道血管造影及介入栓塞治疗,对明确造影剂外溢的直接出血征象患者行动脉栓塞治疗,对造影未发现明确出血动脉的病人行可疑出血动脉经验性栓塞治疗。结果:18例患者中,栓塞成功(栓塞后1周内无再出血)14例,成功率(14/18)77.8%,失败4例,其中死亡2例,转外科手术好转1例,经保守治疗后好转1例;栓塞造影阳性发现(造影检查发现对比剂外溢的直接出血征象)为12例,均行确切病变血管栓塞术,栓塞成功率(10/12)83.3%;6例造影无明显造影剂外溢的患者行经验性栓塞术后继续行内科止血治疗,止血成功率(4/6)66.7%,平均输血量红悬13.7 U、复发出血率(4/18)22.2%、急诊外科手术率(1/18)5.6%及病死率(2/18)11.1%。结论:介入栓塞治疗对于内镜下止血失败或出血量较大无法行内镜止血的非静脉曲张性消化道出血病人止血确切、有效。

Objective： To investigate the effect of interventional embolization in the treatment of acute non-variceal upper gastrointestinal bleeding. Methods： From January 2016 to December 2016, the First Affiliated Hospital of Hainan Medical University, 18 patients with Endoscopic hemostasis failure or endoscopic physician think the patients who were unable to tolerate endoscopic hemostasis in patients with non-variceal upper gastrointestinal bleeding were treated with upper gastrointestinal angiography and interventional embolization. Patients with definite contrast agent spill were treated with arterial angiography and embolization for patients with suspected arterial bleeding. Results： Among the 18 patients, 14 cases were successful with embolization （no recurrence within 1 week after embolization）, and the success rate （14/18） was 77.8%, 4 cases failed, including 2 cases of death and 1 case of surgical treatment improved by conservative treatment 1 case; embolization angiography positive findings （contrast examination found that the contrast agent spill the direct bleeding signs） for 12 cases, were exact lesions of vascular embolization, embolization success rate （10/12） 83.3%; 6 patients were given arterial angiography, no obvious contrast agent spilled patients to give empirical embolization, after surgery to continue medical treatment of hemostasis, hemostasis success rate （4/6） 66.7%： The average blood transfusion rate of patients with gastrointestinal bleeding was 13.7U, the rate of recurrent bleeding was （4/18） 22.2%, the rate of emergency surgery was （1/18） 5.6% and the mortality rate was （2/18） 11.1%. Conclusion： Vascular interventional embolization for endoscopic hemostasis or because of the large amount of bleeding can not be endoscooic hemostasis of patients with non-variceal gastrointestinal bleeding is accurate and effective.