内镜下钛夹标记在消化性溃疡出血经导管栓塞治疗中的临床作用分析

Role of Hemostatic Clips as Guidance during Transcatheter Arterial Embolization in Patients with Peptic Ulcer Bleeding after Endoscopic Treatment Failure

目的探讨消化性溃疡出血内镜治疗失败后,钛夹标记引导经导管栓塞治疗的可行性及临床效果。方法纳入2009年2月−2018年10月于四川大学华西医院因消化性溃疡出血内镜治疗失败后行经导管栓塞治疗的33例患者为研究对象,观察内镜治疗失败后行经导管栓塞治疗的临床成功率、30 d死亡率及并发症发生情况。结果33例患者内镜检查溃疡出血Forrest分级分别为Ⅰa 8例(24.2%)、Ⅰb 14例(42.5%)、Ⅱa 4例(12.1%)、Ⅱb 7例(21.2%)。8例患者视野差未行内镜治疗,25例患者接受内镜治疗,其中7例初次内镜止血治疗失败,18例内镜下止血成功后发生再出血。内镜治疗失败后距经导管栓塞治疗的平均时间为(35.42±67.54)h。所有患者均行血管造影检查,15例血管造影阴性患者X线下8例可见钛夹标记,钛夹引导下行栓塞治疗,7例未见钛夹标记,其中4例患者接受预防性栓塞治疗;余18例血管造影阳性者均予以栓塞治疗。血管造影阴性的患者钛夹引导经导管栓塞治疗临床治疗成功率为75.0%(6/8),无钛夹引导者临床治疗成功率为为28.6%(2/7),血管造影阳性者经导管栓塞治疗临床治疗成功率为66.7%(12/18)。本研究纳入的患者经导管栓塞治疗总体临床成功率为60.0%,30 d死亡率为20.0%,所有患者均未观察到栓塞治疗相关并发症。结论消化性溃疡出血内镜治疗失败患者,钛夹标记引导经导管栓塞治疗是一种行之有效并且安全性高的治疗方式。

Objective To investigate the feasibility and clinical efficacy of transcatheter arterial embolization using hemostatic clips as the guidance in the patients with peptic ulcer bleeding after endoscopic treatment failure.Methods From February 2009 to October 2018,33 patients with peptic ulcer bleeding who were treated with transcatheter arterial embolization after endoscopic treatment failure were included in the study.Clinical success rate,30-d mortality rate and complication rate were observed.Results According to Forrest grading of ulcer bleeding on endoscopy,8 patients(24.2%)were defined asⅠa,14 patients(42.5%)Ⅰb,4 patients(12.1%)Ⅱa,and 7 patients(21.2%)Ⅱb.There were 8 patients not given endoscopic treatment due to poor vision.In 25 patients who received endoscopic treatment,7 patients did not achieve primary endoscopic hemostasis and 18 patients had re-bleeding despite successful primary hemostasis.The mean interval time from endoscopic treatment failure to transcatheter arterial embolization was(35.42±67.54)h.All patients underwent arterial angiography,and 18 patients with positive angiographic findings were treated with embolization.Among the 15 patients with negative angiographic findings,hemostatic clip could be observed fluoroscopically in 8 patients and used as guidance for embolization.Prophylactic embolization was performed in 4 out of 7 patients without visualization of clip fluoroscopically.The clinical success rates in negative angiographic findings patients with and without clip guidance were 75.0%and 28.6%respectively.The clinical success rate with positive angiographic findings was 66.7%.The overall clinical success rate and 30-d mortality rate were 60.0%and 20.0%respectively.No complication related to embolization was observed.Conclusion The preliminary clinical study demonstrates that transcatheter arterial embolization with the guidance of clips is effective and safe for patients with peptic ulcer bleeding after endoscopic treatment failure.