介入栓塞治疗下消化道动脉出血预后系统评价  

System-Analysis of Super-Selective Arterial Embolization in the Treatment of Lower Gastrointestinal Hemorrhage

作　　者：徐新建 吴娟 朱芮 季文斌 XU Xinjian;WU Juan;ZHU Rui(Taizhou Hospital,Wenzhou Medical University,Zhejiang Province 317000,P.R.China)

机构地区：[1]温州医科大学附属台州医院放射科

出　　处：《临床放射学杂志》2018年第7期1200-1203,共4页Journal of Clinical Radiology

摘　　要：目的总结分析下消化道动脉出血介入栓塞治疗的现状。方法在PubMed、Medline、Springer、EBSCO外文数据库中检索,从1996年至2016年共有病例报道39篇,提取其临床资料进行总结分析。结果累计650例患者临床资料纳入本研究。栓塞血管平面：直动脉346支（53.23%）;末级动脉弓（边缘动脉）或直动脉水平32支（4.92%）;末级动脉弓（边缘动脉）12支（1.85%）;未报告260支（40.00%）;栓塞剂选择：单用弹簧圈174例（26.77%）,弹簧圈（和/或）明胶海绵（和/或）PVA 160例（24.62%）是最常用的栓塞剂。预后：即时止血率96%（624/650）;复发出血率12.77%（83/650）;肠缺血并发症率8.00%（52/650）;止血成功率73.85%（480/650）;二期手术率12.77%（83/650）;术后栓塞相关死亡率1.85%（12/650）;术后总体死亡率4.46%（29/650）。结论超选择性血管造影及栓塞是处理下消化道动脉出血相对安全、有效的方法;在栓塞过程中,选择合适的栓塞剂,尽可能地超选择性插管至出血动脉的末级动脉分支实现精准栓塞,是降低肠缺血并发症率及死亡率、提高疗效的关键。Objective To summarize the clinical characteristics of super-selective arterial embolization for the treatment of lower gastrointestinal hemorrhage. Methods A retrospective analysis of 650 cases suffering from lower gastrointestinal hemorrhage was performed. Data of these cases were collected from PubMed、Medline、Springer、EBSCO Database from 1996-2016. Results The embolized target arteries were mainly located in vasa recta（ 346） 、the marginal artery and/or vasa recta（ 32） 、the marginal artery alone（ 12）,while the embolized target arteries in the other 260 cases were not available. Microcoli、microcoli and/or gelatin sponge and/or microcoli were the two leading embolic material in the embolization of mesenteric arterial bleeding. Prognosis： the success rate of achieving immediate hemostasis,96%（ 624/650）; the recurrent bleeding rate,12. 77%（ 83/650）; the bowel wall necrosis rate,8. 00%（ 52/650）; the success rate of achieving complete hemostasis,73. 85%（ 480/650）; the secondary operation rate of patients,12. 77%（ 83/650）; postoperative embolization-related mortality,1. 85%（ 12/650）; postoperative total mortality,4. 46%（ 29/650）. Conclusion Super-selective arterial embolization is a relatively safe and effective option for the management of lower gastrointestinal hemorrhage,however,the right selection of embolized target artery and dosage of emboli should be concerned with avoiding the potential risk of bowel wall necrosis or embolization-related death.

关 键 词：下消化道大出血 肠系膜动脉出血 超选择性插管 栓塞治疗 肠坏死 系统评价 

分 类 号：R57[医药卫生—消化系统]