经动脉栓塞术治疗食管癌出血14例

Transarterial embolization for the treatment of esophageal cancer-induced bleeding:preliminary results in 14 patients

目的 探讨经动脉栓塞术(transarterial embolization,TAE)治疗食管癌出血的有效性及安全性。方法 收集2018年1月至2020年12月行TAE治疗的14例食管癌出血患者的临床资料、技术成功率、临床成功率,严重并发症情况。评估TAE治疗的有效性及安全性。结果 14例患者中导管成功选择性插入靶动脉并行栓塞患者11例。9例患者接受治疗后未再出现出血征象。出血的主要责任血管为胃左动脉7例,支气管动脉6例和食管固有动脉6例。栓塞材料为微弹簧圈、明胶海绵颗粒及聚乙烯醇颗粒。常见不良反应有疼痛、发热,其中1例患者发生食管瘘。结论 对于内科治疗无效的食管癌出血,TAE可以起到良好的疗效。食管瘘作为术后的严重并发症,需特别注意预防。对于胸段食管癌及食管胃交界处癌,最常见的责任血管为胃左动脉、支气管动脉及食管固有动脉。

Objective To discuss the effectiveness and safety of transarterial embolization(TAE) in treating esophageal cancer-induced bleeding.Method The clinical data of 14 patients with esophageal cancer-induced bleeding,who were admitted to authors’ hospital between January 2018 and December 2020to receive TAE,were retrospectively collected.The technical success rate,clinical success rate and severe complications were retrospectively analyzed.The effectiveness and safety of TAE were evaluated.Results A total of 14 patients received TAE treatment.Successful selective catheterization into target artery with subsequent TAE was accomplished in 11 patients.After TAE,no recurrent bleeding occurred in 9 patients.The main responsible arteries included left gastric artery(n=7),bronchial artery(n=6) and proper esophageal artery(n=6).The embolization materials used in TAE procedures included micro-coils,gelatin sponge particles and polyvinyl alcohol particles.The common adverse reactions were pain and fever,and one patient developed esophageal fistula.Conclusion For esophageal cancer bleeding which is ineffective to medical treatment,TAE has excellent curative effect.Esophageal fistula is a serious postoperative complication,to prevention of which special attention should be paid.In esophageal cancers located at thoracic segment of esophagus or at the esophagogastric junction,the most common responsible arteries are the left gastric artery,bronchial artery and proper esophageal artery.(J Intervent Radiol,2022,31:379-383)