Onyx胶栓塞治疗急性消化道动脉性出血的临床应用

Transcatheter Artery Embolization with Onyx for Acute Gastrointestinal Arterial Hemorrhage

目的探讨Onyx栓塞治疗急性消化道动脉性出血的安全性和疗效。方法选取因急性消化道动脉性出血接受Onyx栓塞治疗的患者25例,其中6例应用微弹簧圈及Onyx联合栓塞,余19例均仅行Onyx胶栓塞。术后密切观察患者病情变化,分析技术成功率、临床成功率、再出血率及栓塞相关并发症。结果 25例患者均成功进行栓塞,22例术后出血得到完全控制,临床成功率88%（22/25）。栓塞术后再出血率为8%（2/25）,1例急诊行外科手术,1例再次行Onyx胶栓塞治疗。10例患者存在凝血功能障碍,其中1例术后死于原发性肿瘤病变,余9例术后出血得到完全控制。1例术后发生脾梗死,余24例均未出现肠道坏死、异位栓塞等严重并发症。结论 Onyx胶栓塞治疗急性消化道动脉性出血安全可行,临床疗效满意。

Objective To evaluate the clinical safety and efficacy of superselective embolization with ethylene-vinyl alcohol copolymer（ Onyx Liquid Embolic System） for acute gastrointestinal arterial hemorrhage（ GIH）. Methods Between August 2015 and October 2016,25 patients with confirmed acute GIH underwent emergency endovascular embolization for hemorrhage control. Upper GIH was found in 18 patients and lower GIH in 7 patients. Coils were applied with Onyx in 6 cases and embolization solely with Onyx was performed in 19 cases. Clinical parameters and embolization data were assessed for technical and clinical success rate,rebleeding rate and complications. The results were retrospectively analyzed.Results A 100% technical success rate with immediate cessation of hemorrhage at the end of the session was achieved.Bleeding was controlled in cases who had no rebleeding during follow-up and the clinical success rate was 88%（ 22/25）.Rebleeding occurred in 2 patients（ 8%）,1 was managed with emergency surgery and the secondary embolization therapy was performed in another patient. Splenic infarction was observed in 1 case,and no intestinal ischemia or necrosis was documented among the remaining cases. Of 10 cases with coagulopathy,embolization was performed successfully in 9 cases without rebleeding,and 1 case died from primary tumor of the rectum. Conclusion Control of acute GIH using transcatheter superselective embolization with Onyx is safe and effective.