Lang E K
Department of Radiology, Louisiana State University Medical Center, New Orleans 70112-2822.
Radiology. 1992 Mar;182(3):703-7. doi: 10.1148/radiology.182.3.1535883.
Effectiveness of transcatheter embolization for treatment of bleeding duodenal ulcers was evaluated in 57 patients followed up for at least 5 years. Terminal muscular branch vessel embolization was effective for initial control of bleeding in 27 of 28 cases, and gastroduodenal artery embolization was effective in 25 of 29 (P = .371). Terminal vessel embolization was more effective in attaining long-term control of bleeding (15 of 28 patients) than was gastroduodenal artery embolization (eight of 29) (P = .084). Occlusion of terminal vessels with 6-cyanoacrylate resulted in long-term control of bleeding in nine of 10 patients. With selective embolization of terminal vessels, late complications of duodenal stenosis occurred in seven of 28 patients; when occlusion was at the level of the gastroduodenal artery (P = .131), this developed in only two of 29. Occlusion of the proximal gastroduodenal artery by means of epsilon-aminocaproic acid-induced autologous clot was the most innocuous technique. Retrograde perfusion via the superior mesenteric and inferior pancreaticoduodenal artery (though at a reduced flow rate and pressure gradient) and reconstitution of flow after clot lysis are the theoretical advantages of this technique.
对57例至少随访5年的患者评估了经导管栓塞治疗十二指肠溃疡出血的有效性。终末肌支血管栓塞对28例中的27例出血初步控制有效，胃十二指肠动脉栓塞对29例中的25例有效（P = 0.371）。终末血管栓塞在实现出血长期控制方面（28例患者中的15例）比胃十二指肠动脉栓塞（29例中的8例）更有效（P = 0.084）。用氰基丙烯酸酯闭塞终末血管使10例患者中的9例实现了出血的长期控制。采用终末血管选择性栓塞时，28例患者中有7例发生十二指肠狭窄的晚期并发症；当闭塞在胃十二指肠动脉水平时（P = 0.131），29例中仅2例发生。通过ε-氨基己酸诱导的自体血凝块闭塞胃十二指肠动脉近端是最无害的技术。经肠系膜上动脉和胰十二指肠下动脉逆行灌注（尽管流速和压力梯度降低）以及血凝块溶解后血流重建是该技术的理论优势。
