氰基丙烯酸丁酯胶动脉栓塞治疗急性非静脉曲张性上消化道出血的临床研究

Clinical study of NBCA glue artery embolization in the treatment of acute non-varicose upper gastrointestinal bleeding

目的评价氰基丙烯酸丁酯(NBCA)胶动脉栓塞治疗急性非静脉曲张性上消化道出血的有效性及安全性。方法选取2018年10月至2019年10月在阳春市人民医院肿瘤科二区介入治疗组接受NBCA胶动脉栓塞治疗的急性非静脉曲张性上消化道出血的12例患者作为研究对象,所有患者均经内镜下明确诊断为非静脉曲张性上消化道出血,其中3例为内镜下钛夹治疗24 h后再出血,5例内镜下无法止血,4例患者存在凝血功能障碍。评价NBCA胶动脉栓塞的技术成功率、临床成功率及栓塞相关并发症。结果动脉造影显示对比剂外溢6例,假性动脉瘤6例。所有患者均成功实施NBCA胶动脉栓塞术,动脉栓塞技术成功率为100%。术中NBCA胶与超液化碘油按1∶3的比例混合,NBCA-碘化油混合乳剂的平均用量为1.3 ml(范围0.8~2.2 ml)。术后24 h内出血症状均消失,中位随访10.5个月(范围7~19个月)无再出血病例,临床成功止血率100%。术后3例患者出现局部轻度腹痛,24 h内均自行缓解。所有患者均未出现肠道缺血坏死、异位栓塞等手术相关严重并发症。结论NBCA胶动脉栓塞治疗急性非静脉曲张性上消化道出血安全、有效,适用于内镜下治疗后再出血或无法止血的患者,尤其是合并凝血功能障碍的患者。

Objective To evaluate the efficacy and safety of NBCA glue artery embolization in the treatment of acute non-varicose upper gastrointestinal bleeding.Methods A total of 12 patients with acute non-varicose upper gastrointestinal bleeding who received NBCA glue artery embolization in the interventional therapy group of WardⅡ,Oncology Department of Yangchun People’s Hospital from October 2018 to October 2019 were selected as the research objects.All the patients were clearly diagnosed as non-varicose upper gastrointestinal bleeding under endoscopy,among which 3 patients were bleeding again after 24 hours of treatment with titanium clips under endoscopy,5 patients could not stop bleeding under endoscopy,and 4 patients had coagulation dysfunction.The technical success rate,clinical success rate and embolization-related complications of NBCA glue artery embolization were evaluated.Results Arteriography showed contrast extravasation in 6 patients and pseudoaneurysm in 6 patients.NBCA glue artery embolization was successfully performed in all patients,with success rate of 100%.During the operation,NBCA glue and super-liquid lipiodol were mixed in a ratio of 1:3,and the average dosage of NBCA-lipiodol mixed emulsion was 1.3 ml(in the range of 0.8-2.2 ml).All the bleeding symptoms disappeared within 24 hours after the operation.The median follow-up period was 10.5 months(in the range of 7-19 months),and there were no patients of rebleeding.The clinical successful hemostasis rate was 100%.Local mild abdominal pain occurred in 3 patients after operation,and all of them alleviated by themselves within 24 hours.No patients had intestinal ischemia necrosis,ectopic embolization or other surgery-related serious complications.Conclusion NBCA glue artery embolization is safe and effective in the treatment of acute non-varicose upper gastrointestinal bleeding and is suitable for patients with rebleeding or failure to stop bleeding after endoscopic treatment,especially in patients with coagulation dysfunction.