Loffroy Romaric, Guiu Boris, Cercueil Jean-Pierre, Lepage Côme, Latournerie Marianne, Hillon Patrick, Rat Patrick, Ricolfi Frédéric, Krausé Denis
Department of Vascular and Interventional Radiology, Bocage Hospital, University Hospital Center, 2 boulevard Marechal de Lattre de Tassigny, Dijon Cedex, France.
J Clin Gastroenterol. 2008 Apr;42(4):361-7. doi: 10.1097/MCG.0b013e3180319177.
We evaluated the efficacy and medium-term outcomes of transcatheter embolization to control massive bleeding from gastroduodenal ulcers after failed endoscopic treatment in high-operative-risk patients.
Retrospective study of 35 consecutive emergency embolization procedures in hemodynamically unstable patients (24 men, 11 women, mean age 71+/-11.6 y) referred from 1999 to 2006 for selective angiography after failed endoscopic treatment. Mean follow-up was 27 months.
Endovascular treatment was feasible in 33 patients and consistently stopped the bleeding. "Sandwich" coiling of the gastroduodenal artery was performed in 11 patients and superselective occlusion of the terminal feeding artery with glue, coils, or gelatine particles in 22 patients. Early rebleeding occurred in 6 patients and was managed successfully using endoscopy (n=2), reembolization (n=1), or surgery (n=3). No major complications related to catheterization occurred. Seven patients died within 30 days of embolization and 3 died later during the follow-up, but none of the deaths were due to rebleeding. No late bleeding recurrences were reported.
Selective angiographic embolization is safe and effective for controlling life-threatening bleeding from gastroduodenal ulcers, usually obviating the need for emergency surgery in critically ill patients, whose immediate survival depends on their underlying conditions.
我们评估了经导管栓塞术在控制高手术风险患者内镜治疗失败后胃十二指肠溃疡大出血中的疗效及中期结果。
对1999年至2006年间因内镜治疗失败而转诊进行选择性血管造影的35例血流动力学不稳定患者（24例男性，11例女性，平均年龄71±11.6岁）连续进行的急诊栓塞手术进行回顾性研究。平均随访时间为27个月。
33例患者可行血管内治疗，且均成功止血。11例患者采用胃十二指肠动脉“三明治”式弹簧圈栓塞，22例患者采用胶水、弹簧圈或明胶颗粒对终末供血动脉进行超选择性栓塞。6例患者发生早期再出血，分别通过内镜治疗（2例）、再次栓塞（1例）或手术（3例）成功处理。未发生与导管插入术相关的严重并发症。7例患者在栓塞后30天内死亡，3例在随访期间后期死亡，但均非因再出血死亡。未报告晚期出血复发情况。
选择性血管造影栓塞术对于控制胃十二指肠溃疡危及生命的出血安全有效，通常可避免危重症患者进行急诊手术，其近期生存取决于基础病情。
