经导管栓塞法治疗食管供应动脉出血引起的纵隔血肿

Transcatheter Embolization for Treatment of Mediastinal Hematoma Caused by Esophageal Supplying Arteries' Hemorrhage

目的采用经导管栓塞法治疗食管供应动脉出血所致的纵隔血肿,评估该方法的可行性、安全性及疗效。方法回顾性分析本院2012年6月至2017年7月纵隔血肿患者11例临床及影像学资料,术前均经CT增强或CTA证实为食管供应动脉出血所致。采用明胶海绵联合聚乙烯醇(PVA)颗粒对其行栓塞治疗,术后随访6～12个月,依据术后CT复查及临床症状改善情况评估栓塞效果。结果超选择性血管造影显示出血责任动脉分别来自支气管动脉食管支(7例)、食管动脉(3例)及胃左动脉食管支(1例);9例可见对比剂外溢征象,其中1例为小动脉瘤破裂所致,余2例见左、右支气管动脉食管支吻合,并吻合支增粗、扭曲等畸形表现。所有患者行栓塞治疗后出血立即得以控制,术后5～7天复查CT均未见再出血征象且纵隔血肿均较术前缩小。1例患者于术后3个月死于肺部感染所致的败血症,另1例于术后6个月死于原有食管癌恶化并多器官衰竭,余9例患者术后随访6～12个月未出现任何并发症及再出血征象,且纵隔血肿逐步吸收消失。结论经导管栓塞法治疗食管供应动脉出血引起的纵隔血肿安全可行且效果良好。

Objective To evaluate the safety and effectiveness of transcatheter embolization for mediastinal hematoma caused by esophageal supplying arteries’ bleeding and improve the level of diagnosis and treatment for this kind of disease. Methods Clinical materials of 11 cases,between June 2012 and July 2017,were retrospectively analyzed. All cases were referred to contrast-enhanced CT or CTA prior to the embolization. And the method of transcatheter embolization was performed with combination of gelfoam and PVA particles. The follow-up assessment was performed from 6 to 12 months after the procedure.The outcome was evaluated based on clinical features improvement and CT review. Results Of all cases,the relevant vessels,which were proximal to active bleeding site,arose from esophageal branches of bronchial artery(n=7),esophageal artery(n=3) and esophageal branches of left gastric artery(n=1). Contrast agent extravasation was detected on superselective angiogram in 9 cases,one of which attributed to the rupture of microaneurysm;while vascular malformation was seen at communicating branches of bilateral bronchial artery in 2 cases. All patients had an immediate cessation of hemorrhage after the embolization. No re-bleeding signs were found on repeated CT scans after 5-7 days and the hematoma had been clearly reduced.One patient died from the sepsis of pulmonary infection 3 months after the embolization and the other one died due to esophageal carcinoma deterioration and organs failure 6 months later. 9 cases recovered,and no severe complications or re-bleeding were observed amongt he follow-up period and the mediastinal hematoma resolved completely on serial observation. Conclusion The method of transcatheter embolization is safe and effective for treatment of mediastinal hematoma resulting from the hemorrhage of esophageal supplying arteries,but larger sample analysis is needed to study in-depth.