Funaki B, Kostelic J K, Lorenz J, Ha T V, Yip D L, Rosenblum J D, Leef J A, Straus C, Zaleski G X
Department of Radiology, The University of Chicago Hospitals, 5841 S. Maryland Ave., MC 2026, Chicago, IL 60637, USA.
AJR Am J Roentgenol. 2001 Oct;177(4):829-36. doi: 10.2214/ajr.177.4.1770829.
We evaluated therapeutic microcoil embolization in a group of patients with severe colonic hemorrhage.
Twenty-seven patients with severe colonic bleeding due to diverticular disease (n = 19), angiodysplasia (n = 6), cecal ulcer (n = 1), or unknown cause (n = 1) underwent attempted microcoil embolization (n = 25). Microcatheters were used in all procedures, and embolization was performed at the level of the vasa recta or the marginal artery of Drummond. Branches of the superior mesenteric artery were embolized in 12 patients, branches of the inferior mesenteric artery were embolized in 12 patients, and branches of both the superior and inferior mesenteric arteries were embolized in one patient.
Technical success was achieved in 93% (25/27) of the procedures. However, immediate hemostasis occurred in 96% (26/27) of patients because in one failed procedure, an occlusive dissection of the inferior mesenteric artery arrested bleeding. Three patients rebled within 24 hr. One patient was treated with endoscopic cauterization, and two patients underwent right hemicolectomy. One patient who underwent right hemicolectomy for rebleeding had ischemic changes found on pathologic analysis of the resected specimen, and a second patient who underwent embolization of branches of the superior and inferior mesenteric arteries developed bowel infarction requiring left hemicolectomy. Prolonged clinical success occurred in 81% (22/27) of patients.
Therapeutic microcoil embolization for severe colonic hemorrhage is an effective and well-tolerated procedure.
我们评估了一组严重结肠出血患者的治疗性微线圈栓塞术。
27例因憩室病（n = 19）、血管发育异常（n = 6）、盲肠溃疡（n = 1）或病因不明（n = 1）导致严重结肠出血的患者接受了微线圈栓塞术（n = 25）。所有操作均使用微导管，并在直血管或Drummond边缘动脉水平进行栓塞。12例患者栓塞了肠系膜上动脉分支，12例患者栓塞了肠系膜下动脉分支，1例患者同时栓塞了肠系膜上动脉和肠系膜下动脉分支。
93%（25/27）的操作取得了技术成功。然而，96%（26/27）的患者实现了即时止血，因为在一次失败的操作中，肠系膜下动脉的闭塞性夹层分离止住了出血。3例患者在24小时内再次出血。1例患者接受了内镜烧灼治疗，2例患者接受了右半结肠切除术。1例因再次出血接受右半结肠切除术的患者在切除标本的病理分析中发现有缺血改变，另1例接受肠系膜上动脉和肠系膜下动脉分支栓塞的患者发生了肠梗死，需要进行左半结肠切除术。81%（22/27）的患者取得了长期临床成功。
治疗性微线圈栓塞术治疗严重结肠出血是一种有效且耐受性良好的方法。
