动脉栓塞治疗在医源性消化道出血中的临床应用

Clinical application of arterial embolization in iatrogenic gastrointestinal hemorrhage

目的探讨医源性消化道出血选择性动脉造影及经导管动脉栓塞治疗的临床应用价值。方法选择2012年1月—2018年8月于本院采用数字减影血管造影(DSA)及经导管动脉栓塞治疗的医源性消化道出血患者36例作为研究对象,根据消化道出血情况,采用个体化的动脉栓塞治疗。结果32例造影阳性患者中,即刻止血30例,4例造影阴性患者行试验性栓塞,全部即刻止血,即刻止血率为94.4%(34/36)。止血不彻底者4例,其中3例第二次介入止血成功,另1例经开腹手术止血成功;复发者2例,其中1例再次介入止血成功,另1例再次止血失败者开腹发现肝总动脉糜烂,给予血管修复;复发率为16.7%(6/36)。介入术后随访时间均超过6个月,未出现胃肠道缺血坏死、空腔脏器穿孔等严重并发症。结论选择性动脉数字减影血管造影(DSA)对于医源性消化道出血有较好的诊断效果,经导管动脉栓塞是治疗医源性消化道出血安全有效的方法,具有较高的临床应用价值。

Objective To investigate the clinical application efficacy of selective angiography and trans-catheter arterial embolization for treating iatrogenic gastrointestinal hemorrhage.Methods Thirty-six patients with iatrogenic gastrointestinal hemorrhage treated with digital subtraction angiography(DSA)and trans-catheter arterial embolization from January 2012 to August 2018 were enrolled.Individualized arterial embolization was carried out in these patients according to their gastrointestinal bleeding.Results Of the thirty-two patients with positive angiography,thirty patients showed hemostat effect immediately.Four patients with negative angiography underwent experimental embolization and all of them stopped bleeding immediately.The immediate hemostasis rate was 94.4%(34/36).Four cases of hemostasis were not complete,of which three cases were successful in hemostasis for the second time,and one case was successfully stopped bleeding by laparotomy.Two cases were relapsed,of which one case was successfully interrupted by the second hemostasis and another case failed again.Laparotomy showed that the common hepatic artery was eroded in the patient so that vascular repair was performed.Therefore,the recurrence rate was 16.7%(6/36).The follow-up time after intervention was more than six months.There were no serious complications such as gastrointestinal necrosis and perforation of hollow organs.Conclusions Selective arterial digital subtraction angiography(DSA)is a good diagnostic approach for iatrogenic gastrointestinal hemorrhage.Trans-catheter arterial embolization is a safe and effective method for the treatment of iatrogenic gastrointestinal bleeding,ithas high significant in clinical application.