弹簧圈栓塞治疗门静脉高压性肠道造瘘口出血及疗效分析  

Interventional embolization with coils for the treatment of surgical stoma bleeding caused by portal hypertension:a therapeutic analysis

作　　者：陈峰[1] 陈石伟 乔德林 唐震 

机构地区：[1]宁夏医科大学,750004 [2]上海公利医院肿瘤科 [3]上海公利医院放射科

出　　处：《介入放射学杂志》2010年第11期862-864,共3页Journal of Interventional Radiology

摘　　要：目的评估弹簧圈栓塞治疗门静脉高压性肠道造瘘口出血的可行性及安全性。方法 2008年2月-2010年5月,上海公利医院共收治8例门静脉高压性肠道造瘘口出血患者,其中直肠癌术后4例、乙状结肠癌术后3例、降结肠癌术后1例。所有患者术前均经CTA血管重建检查,经血管造影证实。治疗方法均为经皮穿肝经门静脉至迂曲扩张肠系膜静脉,置入弹簧钢圈栓塞迂曲扩张静脉,同时联合脾栓塞。术后随访2个月至2年,依据CT增强扫描、彩色多普勒超声检查、术后止血率及复发率评估临床疗效。结果所有8例皆1次栓塞成功,均获满意止血,术后无严重并发症。术后1周行增强CT检查,弹簧圈位置均良好,未见曲张静脉增强显影。术后2周彩色多普勒超声检查曲张静脉团内未见血流。本组患者随访期间均未出现造瘘口再出血。结论经皮肝穿经门静脉栓塞曲张静脉治疗门静脉高压性肠道造瘘口出血安全、有效,值得临床推广。Objective To assess the feasibility and safety of interventional embolization with coils in treating surgical stoma bleeding caused by portal hypertension.Methods From February 2008 to May 2010,the authors treated eight patients with surgical stoma bleeding associated with portal hypertension.The patients included 5 females and 3 males,with a mean age of 57 years.The diagnosis was confirmed preoperatively by enhanced CT scanning and vascular reconstruction,and was further verified by angiography after operation.All patients were treated with coil embolization.The percutaneous transhepatic catheterization was performed,after that the catheter was manipulated to pass portal vein into the tortuous dilated mesenteric vein.The bleeding veins were occluded with gelatin sponge,and the spleen was embolized at the same time.The patients were followed up for two months to two years.Based on CT angiographic manifestations,color-Doppler ultrasound findings and clinical conditions the therapeutic results were evaluated.Results Technical success with single procedure was achieved in all eight patients,the hemostasis rate was 100%.No serious complications occurred.During the follow-up period no recurrent bleeding of the surgical stoma was seen.Conclusion For the treatment of surgical stoma bleeding caused by portal hypertension interventional embolization with coils is a safe and effective technique.It is worth popularizing this method in clinical practice.

关 键 词：栓塞治疗 门静脉高压 造瘘 出血 弹簧圈 

分 类 号：R575.2[医药卫生—消化系统]