急性消化道大出血的介入栓塞治疗

Transcatheter embolization for acute gastrointestinal hemorrhage

目的 探讨急性消化道大出血的介入治疗价值和影响疗效的因素。方法 急性消化道大出血 2 6例 ,其中上消化道 11例 ,下消化道 15例。栓塞材料分别为明胶海绵、PVA、弹簧钢圈 3种。下消化道出血采用同轴导管法。结果 2 6例中 2 4例出血成功 ,2例失败。止血成功率为 92 .3% ,无严重并发症。 2 4例失败者均为栓塞后立即止血 ,随访 2～ 12个月无再出血。 2例超选择性插管失败为保守治疗时间过长 ,内脏血管收缩所致。结论 使用不同方法介入栓塞治疗急性消化道大出血是有效而安全的 ,正确选择栓塞靶血管和合适的栓塞剂及用量是成功的关键。

Objective: To study the value and relevant factors of international therapy in acute gastrointestial hemorrhage. Methods: Twenty-six patiens with acute gastrointestinal hemorrhage were embolized by one of the methods of Polyvinyl Alcohol(PVA), gelfoam or metal coils. Eleven of the twenty-six patients were upper gastrointestinal hemorrhage,the other cases were lower gastrointestinal heomorrhage which were embolized using coaxial microcatheter.Results: Twenty-four of the twenty-six patients were treated successfully by these methods, hemorrhage was stopped immediately, and there was no severe complication in the group and no recurrent hemorrhage in follow-up for 2～12 months. The success rate reached 92.3%.In two patients, super selective catheterization to permit embolization could not be achieved due to splanchnic vasospasm.Conclusions: Transcatheter embolization foracute massive gastrointestinal hemorrhage is safe and efficient using different methods. The key of success is the right selection of embolized target artery and dosage of emboli.