Kuo William T, Lee David E, Saad Wael E A, Patel Nikhil, Sahler Lawrence G, Waldman David L
Department of Diagnostic Radiology, Division of Vascular and Interventional Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
J Vasc Interv Radiol. 2003 Dec;14(12):1503-9. doi: 10.1097/01.rvi.0000099780.23569.e6.
To evaluate the safety and effectiveness of superselective microcoil embolization for the treatment of lower gastrointestinal (LGI) hemorrhage.
A retrospective review of LGI superselective microcoil embolization data for a 10-year period was performed. During this period, twenty-two patients with evidence on angiography of LGI bleeding underwent superselective microcoil embolization. Hemorrhage was treated in the colon (n = 19) and jejunum (n = 3). Ivalon was used adjunctively in two patients and gelfoam was used as a secondary agent in two additional patients. Postembolization ischemia was evaluated objectively in 14 patients by colonoscopy (n = 10), surgical specimen (n = 3), and barium enema (n = 1). All patients were followed for clinical evidence of bowel ischemia. Four patients died before further follow-up could be performed. Additionally, 122 cases of LGI hemorrhage treated with superselective microcoil embolization were identified in a review of the literature. A meta-analysis was then performed, combining the data in this study and the data from the literature, to estimate the rate of major and minor ischemic complications on a total of 144 superselective microcoil embolizations.
Immediate hemostasis was achieved in all 22 patients in this study. Complete clinical success was achieved in 86% of patients (19 of 22 patients). Rebleeding occurred in 14% of patients (3 of 22 patients) and each underwent colonoscopic intervention with success. Postembolization objective follow-up was performed in 64% of patients (14 of 22 patients). Ten patients underwent follow-up colonoscopy; one patient received a follow-up barium enema; and three patients underwent subsequent surgery. Colonic resection (one partial and one total) was performed in two patients. The partial colectomy was performed in a patient who had been diagnosed with colonic polyps and dysplasia. The total colectomy was performed on a patient with history of chronic LGI bleeding complicated by long-term anticoagulation therapy and a history of tubular adenoma resection. The third surgical patient (16 months old) underwent a follow-up exploratory laparotomy after embolization of a proximal jejunal branch of the superior mesenteric artery. None of the three patients who underwent surgery were found to have postembolic ischemic changes in the bowel specimen. Four patients in this study died, for reasons unrelated to hemorrhage or embolization, before further follow-up could be performed. The last four patients were followed clinically and experienced no symptoms of intestinal ischemia. A minor ischemic complication was reported in 4.5% of patients (1 of 22 patients), and there were no major ischemic complications (0%) in this series. A review of the data from 122 cases of LGI superselective microcoil embolization in the literature is also presented. Combined with the data in this study, the minor complication rate was 9% (13 of 144 patients), and the major complication rate was 0% (0 of 144 patients).
Superselective microcoil embolization is a safe and effective treatment for LGI hemorrhage.
评估超选择性微线圈栓塞术治疗下消化道（LGI）出血的安全性和有效性。
对10年间LGI超选择性微线圈栓塞术的数据进行回顾性分析。在此期间，22例经血管造影证实为LGI出血的患者接受了超选择性微线圈栓塞术。出血部位在结肠（n = 19）和空肠（n = 3）。2例患者辅助使用了Ivalon，另外2例患者使用明胶海绵作为辅助剂。14例患者通过结肠镜检查（n = 10）、手术标本（n = 3）和钡灌肠（n = 1）对栓塞后缺血情况进行了客观评估。所有患者均接受随访，观察肠道缺血的临床证据。4例患者在能够进行进一步随访之前死亡。此外，通过文献回顾确定了122例接受超选择性微线圈栓塞术治疗的LGI出血病例。然后进行荟萃分析，将本研究中的数据与文献中的数据相结合，以评估总共144例超选择性微线圈栓塞术中严重和轻微缺血并发症的发生率。
本研究中的22例患者均实现了即刻止血。86%的患者（22例中的19例）获得了完全的临床成功。14%的患者（22例中的3例）发生再出血，均接受结肠镜干预并成功。64%的患者（22例中的14例）进行了栓塞后客观随访。10例患者接受了随访结肠镜检查；1例患者接受了随访钡灌肠；3例患者接受了后续手术。2例患者进行了结肠切除术（1例部分切除和1例全切除）。部分结肠切除术是在1例被诊断为结肠息肉和发育异常的患者中进行的。全结肠切除术是在1例有慢性LGI出血病史并长期接受抗凝治疗且有管状腺瘤切除史的患者中进行的。第3例手术患者（16个月大）在肠系膜上动脉近端空肠分支栓塞后接受了随访性剖腹探查术。接受手术的3例患者中，在肠道标本中均未发现栓塞后缺血改变。本研究中有4例患者在能够进行进一步随访之前死亡，原因与出血或栓塞无关。最后4例患者接受临床随访，未出现肠道缺血症状。4.5%的患者（22例中的1例）报告有轻微缺血并发症，本系列中无严重缺血并发症（0%）。还展示了对文献中122例LGI超选择性微线圈栓塞术数据的回顾。与本研究中的数据相结合，轻微并发症发生率为9%（144例中的13例），严重并发症发生率为0%（144例中的0例）。
超选择性微线圈栓塞术是治疗LGI出血的一种安全有效的方法。
