CAJ | 학술논문

目的探讨应用组织胶经导管动脉栓塞治疗各种急性消化道动脉出血的可行性与临床疗效.方法回顾性分析因消化道动脉出血接受组织胶栓塞治疗患者24例,包括上消化道出血14例、下消化道出血10例.栓塞剂为组织胶与碘油混合液.其中4例在外院行弹簧圈、颗粒栓塞治疗无效后应用组织胶栓塞治疗,其余20例均首先应用组织胶进行栓塞.术后严密监测患者病情变化,对技术成功率、临床成功率、再出血率及栓塞相关并发症进行分析.结果 24例患者均成功进行栓塞,21例患者术后出血完全控制,临床成功率87.5％(21/24).2例患者组织胶栓塞后发生再出血,其中1例行急诊外科手术;1例再次行组织胶栓塞治疗,术后未发生再出血.20例患者术后出现局部轻度腹痛,24 h内均自行缓解.13例存在凝血功能障碍的患者中,1例患者因弥散性血管内凝血于栓塞术后20 h死亡,12例出血均得到有效控制,临床成功率达92.3％(12/13).组织胶栓塞后所有患者均未出现肠道坏死、异位栓塞等严重并发症.结论应用组织胶介入栓塞治疗急性消化道动脉出血安全可行、临床疗效满意.
목적 탐토응용조직효경도관동맥전새치료각충급성소화도동맥출혈적가행성여림상료효.방법 회고성분석인소화도동맥출혈접수조직효전새치료환자24례,포괄상소화도출혈14례、하소화도출혈10례.전새제위조직효여전유혼합액.기중4례재외원행탄황권、과립전새치료무효후응용조직효전새치료,기여20례균수선응용조직효진행전새.술후엄밀감측환자병정변화,대기술성공솔、림상성공솔、재출혈솔급전새상관병발증진행분석.결과 24례환자균성공진행전새,21례환자술후출혈완전공제,림상성공솔87.5％(21/24).2례환자조직효전새후발생재출혈,기중1례행급진외과수술;1례재차행조직효전새치료,술후미발생재출혈.20례환자술후출현국부경도복통,24 h내균자행완해.13례존재응혈공능장애적환자중,1례환자인미산성혈관내응혈우전새술후20 h사망,12례출혈균득도유효공제,림상성공솔체92.3％(12/13).조직효전새후소유환자균미출현장도배사、이위전새등엄중병발증.결론 응용조직효개입전새치료급성소화도동맥출혈안전가행、림상료효만의.
Objective To evaluate the feasibility and efficacy of transcatheter arterial embolization with tissue adhesive for the treatment of acute gastrointestinal arterial hemorrhage.Methods Endovascular embolization performed in 24 patients (15 male and 9 female,aged 28-87,mean age,41 years) with angiographic appearance of contrast extravasion,pseudoaneurysm,enlarged and tortuous vessels was retrospectively analyzed.Upper gastrointestinal hemorrhage was found in 14 patients and lower gastrointestinal hemorrhage in 10 patients.Transcatheter superselective embolization was performed with the mixture of N-butyl cyanocrylate (NBCA) and iodized oil.Among them,4 patients who were not cured by embolization with coils and embolic particles were transferred to our hospital,receiving transcatheter arterial embolization with tissue adhesive.We chose tissue adhesive as the embolic agents of first choice in the remaining 20 patients.The technical and clinical success rate,rebleeding rate and complications were summarized.Results The technical success rate was 100.0％ (24/24).The bleeding was controlled in 21 patients who had no rebleeding during follow-up period and the clinical success rate was 87.5％ (21/24).Rebleeding occurred in two patients,one was managed with emergency surgery and the other underwent the second embolization therapy.Mild abdominal pain occurred in 20 patients with spontaneous symptom alleviation within 24 hours after embolization.One patient died of disseminated inravascular coagulation at 20 hours after the procedure.Of 13 cases with coagulation dysfunction,embolization was successful in 12patients (92.3％) without rebleeding.Neither ectopic embolism nor severe complications such as intestinal necrosis was observed.Conclusion Transcatheter superselective embolization with the mixture of NBCA and iodized oil is a safe and effective treatment for acute gastrointestinal arterial hemorrhage.