“三明治法”栓塞治疗急性十二指肠溃疡出血的疗效分析  

Interventional Embolization by Sandwich Technique for Acute Duodenal Ulcers Hemorrhage: A Therapeutic Analysis

作　　者：赵玮[1] 王伟中[1] 

机构地区：[1]广州军区广州总医院介入治疗中心,510010

出　　处：《临床放射学杂志》2015年第10期1655-1659,共5页Journal of Clinical Radiology

摘　　要：目的评估＂三明治法＂栓塞治疗急性十二指肠溃疡出血的临床疗效。方法 2008年10月至2014年4月间,30例内镜证实的十二指肠活动性溃疡出血且止血失败的患者,采用明胶海绵、钢圈结合的＂三明治法＂栓塞胃十二指肠动脉。治疗方法为先经导管置入弹簧圈栓塞胃网膜右动脉起始段,再后撤微导管以弹簧圈及明胶海绵颗粒栓塞胃十二指肠动脉出血分支、周边分支,最后以弹簧圈栓塞胃十二指肠动脉主干,即所谓＂三明治法＂,腹腔干及肠系膜上动脉造影显示栓塞部位覆盖内镜指示的出血部位,视为栓塞成功。术后对所有病例进行为期6～72个月的追踪随访,记录技术成功率、一次栓塞成功率、二次栓塞成功率、再出血率、死亡率。结果 21例动脉造影可见对比剂外溢征象（70%）,9例未见对比剂外溢直接出血征象（30%）,30例患者成功行32次栓塞,栓塞技术成功率100%,一次栓塞成功率83.3%（25/30）,5例（16.7%）再出血中2例行二次栓塞出血停止,二次栓塞成功率90.0%（27/30）,1例转外科手术出血停止（3.3%）,2例因出血并发多器官功能衰竭死亡（6.7%）,栓塞止血成功的27例经内科治疗后,随访6～72个月未见复发出血。1例患者在动脉栓塞术后12 h出现无症状性胰酶增高,60 h后恢复正常（3.3%）,未出现肠缺血坏死及肠道狭窄。结论 ＂三明治法＂栓塞治疗十二指肠溃疡出血安全、有效。Objective To investigate the clinical effectiveness of gastroduodenal artery（ GDA） embolization with sandwich technique in bleeding duodenal ulcers（ DU）. Methods Between October 2008 and April 2014,Thirty patients with endotherapy failed bleeding DU,Whether there has angiographic proof of extravasation or not,GDA were embolized by sandwich technique with gelfoam between metallic coils. The sandwich technique is： the catheter is pushed to the origin of the RGEA and coils are introduced as the catheter is withdrawn to the proximal GDA. Complete embolization of the GDA,which includes responsible 、proximal and distal artery embolization and exclusion of its two side branches with gelfoam between metallic coils. Technical success is defined as failure of contrast medium opacification of the embolized segments of the GDA and its muscular branches supplying the endoscopically identified bleeding site,during coeliac as well as superior mesenteric artery（ SMA） angiography. All patients were followed up for six to seventy-two months. The clinical profile of the patients、re-bleeding and mortality rates were recorded. Results Twenty-one patients with angiographic proof of extravasation were found（ 70%）,and nine patients without angiographic proof of extravasation were found（ 30%）. Thirty-two embolizations were successfully performed in the thirty patients with a technical success rate of 100%. In twenty-five patients,transarterial embolization（ TAE） could achieve an in hospital cessation of bleeding without further endoscopic、radiological、or surgical intervention,primary clinical success is 83. 3%（ 25 /30）. Early re-bleeding was noted in five patients（ 16. 7%）,two of five patients with recurrent bleed,repeat angioembolization achieved haemostasis,the secondary clinical success rate of TAE was 90. 0%（ 27 /30）. One patient required surgical intervention（ 3. 3%）. There were two death with Multiple Organ Dysfuction Syndrome（ MODS）. The pancreatic enzymes of one patient was in

关 键 词：十二指肠溃疡 出血 栓塞 

分 类 号：R573.1[医药卫生—消化系统]