危重症十二指肠球部溃疡大出血的急诊动脉栓塞治疗  

Emergency transcatheter arterial embolization for critical massive bleeding due to duodenal bulb ulcer

作　　者：李强[1] 李宜云[1] 赵春梅[1] 

机构地区：[1]苏州上海交通大学医学院苏州九龙医院介入科,苏州215021

出　　处：《介入放射学杂志》2011年第6期476-478,共3页Journal of Interventional Radiology

摘　　要：目的探讨危重症十二指肠球部溃疡大出血经导管急症动脉栓塞术(ETAE)的临床疗效及可行性。方法 7例十二指肠球部溃疡大出血的患者,均经内镜检查确诊,临床表现危重,内科保守治疗无效后行ETAE:经右股动脉入路插管行超选择性胃十二指肠动脉或和胃网膜右动脉造影,判定出血动脉后使用合适大小明胶海绵颗粒和不锈钢圈尽量接近出血动脉栓塞。术后继续内科用药,内镜复查、随访。结果胃十二指肠动脉造影出血阳性率7/7,手术成功率7/7,完全有效率6/7,部分有效率1/7,无并发症发生。结论 ETAE是治疗危重症十二指肠球部溃疡大出血高效、安全的急救手段,可作为外科手术的替代方法推广应用。Objective To evaluate the efficacy and feasibility of emergency transcatheter arterial embolization（ETAE） in treating critical massive bleeding due to duodenal bulb ulcer.Methods ETAE was carried out in seven patients with acute massive bleeding due to endoscopically-proved duodenal bulb ulcer,who failed to respond conservative measures and were critically ill clinically.Super-selective catheterization of gastroduodenal artery or right gastroepiploic artery was performed,which was followed by arterial angiography to identify the bleeding site.According to the angiographic findings,ETAE with Gelfoam particles and coils was carried out.After the operation medical management was given and endoscopy re-examination was conducted.All the patients were followed up for 3 ～ 6 months.Results Angiographically,gastroduodenal artery bleeding was detected in all seven patients.ETAE was successfully accomplished in all cases.Complete clinical effectiveness was obtained in six patients while partial effectiveness in one case.No procedure-related complications occurred.Conclusion For critical massive bleeding due to duodenal bulb ulcer ETAE is a highly effective and safe treatment,which can be regarded as an alternative to surgery.It is worth popularizing this technique in clinical practice.

关 键 词：十二指肠球部溃疡 大出血 经导管栓塞术 血管造影 超选择性插管 

分 类 号：R573.1[医药卫生—消化系统]