小颗粒栓塞物质在介入栓塞治疗肠道出血中的应用体会

Application of small-particle embolic material in embolization for intestinal bleeding

目的探讨小颗粒栓塞物质在超选择性动脉栓塞治疗肠道出血的临床疗效。方法选取36例肠道出血患者行选择性动脉造影检查,明确出血部位后,采用Embosphere微球、明胶海绵颗粒等小颗粒栓塞物质对出血动脉行超选择性栓塞治疗,对动脉造影表现及治疗效果进行回顾性分析。结果动脉造影表现:肠系膜上动脉出血24例(24/36);肠系膜下动脉出血7例(7/36);胃十二指肠动脉出血3例(3/36);2例患者动脉血管造影未发现明确出血动脉(2/36),后转入外科行切除治疗;32例患者达到成功止血,技术成功率94.1%。2例患者术后再次出血,行第二次栓塞治疗后成功止血,其中1例患者时隔半年再次入院,但造影检查,先后两次出血部位不同。术后随访12个月,所有经介入治疗后患者均未发现肠坏死及异位栓塞等严重并发症。结论小颗粒栓塞物质在治疗肠道出血的超选择性动脉栓塞中,是一类较为安全、有效的栓塞物质。

Objective To investigate the clinical efficacy of small-particle embolic material in the treatment of intestinal hemorrhage with superselective arterial embolization.Methods Thirty-six patients with intestinal hemorrhage underwent selective angiography.After identifying the bleeding site,ultra-selective embolization of hemorrhagic arteries was performed with embolization materials such as embosphere microspheres and gelatin sponge particles.The angiographic findings and therapeutic effects were retrospectively analyzed.Results The results of angiography inchuded 24 cases of superior mesenteric artery hemorrhage(24/36),7 cases of subenteral artery hemorrhage(7/36),3 cases of gastroduodenal artery hemorrhage(3/36),and 2 cases of no clear hemorrhage(2/36)who were then transferred to surgical resection.32 patients achieved successful hemostasis with a technical success rate of 94.1%.Two patients had hemorrhage after operation and hemostasis was successfully performed after the second embolization treatment.One patient was admitted to the hospital half a year later but the angiographic examination showed two different bleeding sites.After 12 months of follow-up,no serious complications such as intestinal necrosis and ectopic embolism were found in all patients after interventional embolization.Conclusion Small-particle embolic material is a safe and effective embolic material in superselective arterial embolization for intestinal bleeding.