Luchtefeld M A, Senagore A J, Szomstein M, Fedeson B, Van Erp J, Rupp S
Digestive Disease Services, The Ferguson Clinic-Spectrum Health-Ferguson Center, Grand Rapids, Michigan, USA.
Dis Colon Rectum. 2000 Apr;43(4):532-4. doi: 10.1007/BF02237200.
Transcatheter arterial embolization has been used as a therapeutic maneuver for lower gastrointestinal bleeding. The availability of highly selective arteriography has made this procedure safer and warrants re-evaluation.
A retrospective chart review was done of all patients undergoing arteriography for presumed lower gastrointestinal bleeding at two acute-care community hospitals. Causes of bleeding, clinical outcome, and complications caused by transcatheter arterial embolization were recorded.
There were 26 arteriographically identified bleeding sites in the colon and small bowel. The most frequent cause of bleeding was diverticulosis (12 patients), with the diagnosis being arterio venous malformation in two, and one unknown colonic source. Transcatheter arterial embolization was attempted for 17 separate bleeding episodes in 16 patients. Transfusion requirements were an average (+/- standard deviation) of 7 +/- 1.43 units per patient. Transcatheter arterial embolization was successful in stopping bleeding in 14 cases (82 percent). Two patients had surgery after transcatheter arterial embolization: one for colonic necrosis and one for persisting bleeding. There were two more unsuccessful procedures; one had a successful repeated transcatheter arterial embolization, and one stopped spontaneously. One patient rebled during the same hospitalization and was controlled with intra-arterial vasopressin. There were two deaths, both secondary to sepsis unrelated to the transcatheter arterial embolization or the gastrointestinal tract.
Transcatheter arterial embolization is a relatively safe and successful procedure in patients with massive lower gastrointestinal hemorrhage. It is an excellent choice of therapy for patients that are poor candidates for surgery, but its role in other patients remains to be defined.
经导管动脉栓塞术已被用作下消化道出血的一种治疗手段。高选择性动脉造影的应用使该手术更安全，值得重新评估。
对两家急症社区医院所有因疑似下消化道出血而接受动脉造影的患者进行回顾性病历审查。记录出血原因、临床结果以及经导管动脉栓塞术引起的并发症。
在结肠和小肠中通过动脉造影确定了26个出血部位。最常见的出血原因是憩室病（12例患者），2例诊断为动静脉畸形，1例结肠出血来源不明。16例患者中17次单独的出血发作尝试了经导管动脉栓塞术。每位患者的平均（±标准差）输血需求量为7±1.43单位。经导管动脉栓塞术成功止血14例（82%）。2例患者在经导管动脉栓塞术后接受了手术：1例因结肠坏死，1例因持续出血。还有2例手术未成功；1例成功进行了重复经导管动脉栓塞术，1例出血自行停止。1例患者在同一住院期间再次出血，通过动脉内注射血管加压素得以控制。有2例死亡，均继发于与经导管动脉栓塞术或胃肠道无关的败血症。
经导管动脉栓塞术对于大量下消化道出血患者是一种相对安全且成功的手术。对于手术条件较差的患者，它是一种极佳的治疗选择，但其在其他患者中的作用仍有待确定。
