Defreyne L, Vanlangenhove P, De Vos M, Pattyn P, Van Maele G, Decruyenaere J, Troisi R, Kunnen M
Departments of Radiology and Medical Imaging, University Hospital of Gent, De Pintelaan 185, B-9000 Gent, Belgium.
Radiology. 2001 Mar;218(3):739-48. doi: 10.1148/radiology.218.3.r01mr05739.
To determine technical and clinical results of embolization of endoscopically unmanageable nonvariceal gastrointestinal hemorrhage (GIH).
Results of 40 embolizations in 91 patients who underwent arteriography for acute nonvariceal GIH were retrospectively studied. GIH was upper, lower, or transpapillar (hemobilia, pancreatic duct bleeding). Clinical parameters and embolization data were assessed for clinical success and in-hospital survival.
Technical success (bleeding target devascularization) was achieved in all patients except one with upper GIH (39 [98%] of 40 patients). No bowel complications occurred. One partial liver lobe and one partial spleen infarction were noted. Five (13%) of 39 patients bled again within 3 days; all had upper GIH (P =.049). Clinical success (no rebleeding after 30 days) was achieved in 32 (82%) of 39 patients. Clinical success occurred in 13 (68%) of 19 patients with upper GIH, in 10 (91%) of 11 with lower GIH, and in all with transpapillar GIH (P =.084). Mortality rate was 28% (11 of 40 patients), equally spread over upper, lower, and transpapillar GIH (P =.87). Blood loss (hemoglobin level < 80 g/L, P =.041), use of packed cells (P =.049) and fresh frozen plasma (P =.006); shock (P =.047); and corticosteroid use (P =.036) were related to rebleeding. Shock (P =.039) and use of fresh frozen plasma (P =.003) before embolization and rebleeding (P =.012), coagulopathy (P =.007), and need for surgery (P =.03) after embolization were strongly correlated with mortality.
Embolization is an effective first approach with lower and transpapillar GIH after endoscopy; it was less effective with upper GIH.
确定内镜治疗难以控制的非静脉曲张性胃肠道出血（GIH）的栓塞技术及临床效果。
回顾性研究91例因急性非静脉曲张性GIH接受动脉造影的患者的40次栓塞治疗结果。GIH分为上消化道、下消化道或经乳头（胆道出血、胰管出血）。评估临床参数和栓塞数据以确定临床成功率和住院生存率。
除1例上消化道GIH患者外，所有患者均实现技术成功（出血靶血管去血管化）（40例患者中的39例[98%]）。未发生肠道并发症。发现1例部分肝叶梗死和1例部分脾梗死。39例患者中有5例（13%）在3天内再次出血；均为上消化道GIH（P = 0.049）。39例患者中有32例（82%）取得临床成功（30天内无再出血）。19例上消化道GIH患者中有13例（68%）取得临床成功，11例下消化道GIH患者中有10例（91%）取得临床成功，所有经乳头GIH患者均取得临床成功（P = 0.084）。死亡率为28%（40例患者中的11例），在上消化道、下消化道和经乳头GIH中分布均匀（P = 0.87）。失血（血红蛋白水平<80 g/L，P = 0.041）、使用浓缩红细胞（P = 0.049）和新鲜冰冻血浆（P = 0.006）；休克（P = 0.047）；以及使用皮质类固醇（P = 0.036）与再出血有关。栓塞前休克（P = 0.039）、使用新鲜冰冻血浆（P = 0.003）以及再出血（P = 0.012）、凝血功能障碍（P = 0.007）和栓塞后需要手术（P = 0.03）与死亡率密切相关。
栓塞是内镜治疗后下消化道和经乳头GIH的一种有效的首选方法；对上消化道GIH效果较差。
