经导管动脉栓塞治疗急性十二指肠溃疡大出血29例  

Transcatheter arterial embolization for patients with acute massive hemorrhage of duodenal ulcer: an analysis of 29 cases

作　　者：王永利[1] 程英升[2] 张家兴[1] 汝复明[1] 曹传武[1] 徐霁充[1] 

机构地区：[1]同济大学附属上海第十人民医院介入科,上海市200072 [2]上海交通大学附属第六人民医院介入影像科,上海市200233

出　　处：《世界华人消化杂志》2008年第31期3571-3575,共5页World Chinese Journal of Digestology

摘　　要：目的:评价急诊经导管动脉栓塞术(emergency transcatheter arterial embolization,ETAE)治疗十二指肠溃疡大出血的有效性和安全性.方法:收集1997-01/2007-11我院ETAE治疗的十二指肠溃疡动脉性大出血的29例患者资料.分别行腹腔干动脉、胃十二指肠动脉造影,以明确出血动脉,采用明胶海绵颗粒或条经造影导管或微导管栓塞胃十二指肠动脉或其出血分支动脉,ETAE后均行肠系膜上动脉造影,排除侧支循环对溃疡区域供血.分析ETAE的技术成功率和临床成功率,内镜观察十二指肠球部动脉栓塞区黏膜改变.结果:导管位于腹腔干动脉造影,出现造影剂外渗7例,出血阳性率24%;胃十二指肠动脉造影,造影剂外渗、涂抹肠黏膜19例,出血阳性率65.5%;3例内镜明确诊断十二指肠溃疡,但胃十二指肠动脉造影出血阴性.1例ETAE后,有肠系膜上动脉的胰十二指肠前下、后下弓动脉侧支供血,再予以微导管栓塞肠系膜上动脉上述两分支动脉.ETAE即刻止血26例,技术成功率90%;ETAE后30d内未再出血27例,2例饮酒再出血,再行ETAE,临床成功率93%.5例出现一过性剑突下隐痛,未作处理自行缓解.19例患者ETAE术后内镜检查,10例ETAE前已查内镜者7例治疗后复查内镜,显示动脉栓塞区域的十二指肠黏膜呈苍白改变,无缺血坏死病例.结论:明胶海绵颗粒或条行ETAE是急诊治疗十二指肠溃疡性动脉出血的迅捷、有效和安全手段.AIM： To evaluate the efficacy and safety of emergency transcatheter arterial embolization （ETAE） for patients with acute massive hemorrhage of duodenal ulcer. METHODS： Twenty-nine consecutive patients with acute massive bleeding of duodenal ulcer admitted to our hospital from 1997 through 2007 were analyzed. Superselective angiographies at celiac arteries, gastroduodenal arteries were performed to find out the bleeding sites before ETAE, then, embolotherapy was done with gelatin sponge particles or microstrips via 5French angiographic catheter or 3French microcatheter. After ETAE, another superior mesenteric arterioangiography was undertaken in case of collat- eral circulation supplied to areas of duodenal ulcer. Technique success rate and clinical success rate were analyzed. Changes of the mucous membrane, were observed using endoscopy following ETAE. RESULTS： Angiographies showed active bleeding with extravasation of contrast medium in 7 cases with 24% positive rate of bleeding at celiac arteries, and in 19 cases, 65.5% at gastroduodenal arteries. No bleeding signs of angiography were shown in 3 cases who undertook endoscopy prior to ETAE. Twenty-six patients achieved immediate hemostasis and technique success rate reached 90%. No hemostasis was observed in 27 patients within 30 days after ETAE and clinical success rate was 93%. Recurrent hemor- rhage occurred in 2 patients who drank wine a lot were treated by a second embolotherapy in the same way. Five patients underwent transient ischem with light abdominal pain under xiphoid, spontaneous restoration without special treatment. No mucous necrosis happened to 29 cases for ischem of gastroduodenal arteries embolized. CONCLUSION： Tranascatheter arterial emoblization is an effective and safe measure to control acute massive bleeding of duodenial ulcer.

关 键 词：急诊经导管栓塞 大出血 十二指肠溃疡 血管造影 

分 类 号：R573.1[医药卫生—消化系统]