经导管动脉栓塞治疗内镜治疗失败的非静脉曲张性上消化道出血疗效分析

Transcatheter arterial embolization for nonvariceal gastrointestinal hemorrhage after failed endoscopic hemostasis

目的探讨经导管动脉栓塞治疗内镜下治疗失败的非静脉曲张性上消化道出血的临床疗效。方法2011年1月至2020年7月我科对109例内镜下治疗失败的非静脉曲张性上消化道出血患者行血管造影及栓塞治疗,对于造影阳性患者,进行病变动脉的栓塞治疗;对造影未发现出血征象的阴性患者,根据内镜检查确认的出血部位行经验性血管栓塞治疗。结果109例患者共行介入检查109次,阳性发现45例,造影无阳性发现64例。栓塞治疗技术成功率100%;经验性栓塞技术成功率100%。30 d内再出血率27.52%(30/109),晚期再出血率1.83%(2/109);总临床有效率72.47%,其中治疗性栓塞临床有效率66.67%(30/45),经验性/预防性栓塞临床有效率74.14%(43/58)。两组技术成功率、临床成功率、短期及长期出血复发率方面无显著差异。所有患者均未出现介入相关并发症。结论对内镜下治疗失败的非静脉曲张行上消化道出血,经动脉导管栓塞治疗是安全有效的,术前的内镜检查对介入治疗有重要的指导意义。

Objective To investigate the clinical efficacy of interventional embolization treatment for nonvariceal gastrointestinal hemorrhage after failed endoscopic treatment.Methods From January 2011 to July 2020,109 patients with nonvariceal gastrointestinal bleeding after failed endoscopic hemostasis treatment were treated with angiography and endovascular interventional treatment in our department.For patients with positive angiography,embolization of diseased arteries was performed.For negative patients with no signs of hemorrhage on angiography,empirical embolization was performed according to the hemorrhage site confirmed by endoscopy.Results 109 interventional angiographies were performed on 109 patients.Interventional embolization was performed in 45 patients who had definite bleeding sign on angiogram.64 patients had no bleeding sign were performed empirical embolization.The technical success rate of embolization and empirical embolization was 100%.The rate of recurrent hemorrhage within 30 days was 27.52%(30/109),The late rehaemorrhagia rate was 1.83%(2/109).The total effective rate was 72.47%,including 66.67%(30/45)for therapeutic embolization and 74.14%(43/58)for empirical/prophylactic embolization.There were no significant differences in technical success rate,clinical success rate,short-term and long-term bleeding recurrence rate between the two groups.No serious complications were observed in our data.Conclusions Transcatheter arterial embolization is safe and effective for nonvariceal gastrointestinal hemorrhage after failed endoscopic treatment,and preoperative endoscopy has important guiding significance for interventional therapy.