Department of Radiology, Leeds General Infirmary, Leeds, UK.
Clin Radiol. 2011 Jun;66(6):500-9. doi: 10.1016/j.crad.2010.11.016. Epub 2011 Mar 2.
To assess the published evidence on the endovascular treatment of non-variceal upper gastrointestinal haemorrhage.
An Ovid Medline search of published literature was performed (1966-2009). Non-English literature, experimental studies, variceal haemorrhage and case series with fewer than five patients were excluded. The search yielded 1888 abstracts. Thirty-five articles were selected for final analysis.
The total number of pooled patients was 927. The technical and clinical success of embolization ranged from 52-100% and 44-100%, respectively. The pooled mean technical/clinical success rate in primary upper gastrointestinal tract haemorrhage (PUGITH) only, trans-papillary haemorrhage (TPH) only, and mixed studies were 84%/67%, 93%/89%, and 93%/64%, respectively. Clinical outcome was adversely affected by multi-organ failure, shock, corticosteroids, transfusion, and coagulopathy. The anatomical source of haemorrhage and procedural variables did not affect the outcome. A successful embolization improved survival by 13.3 times. Retrospective comparison with surgery demonstrated equivalent mortality and clinical success, despite embolization being applied to a more elderly population with a higher prevalence of co-morbidities.
Embolization is effective in this very difficult cohort of patients with outcomes similar to surgery.
评估非静脉曲张性上消化道出血的血管内治疗的已有文献证据。
对已发表的文献进行了 Ovid Medline 检索（1966-2009 年）。排除了非英文文献、实验研究、静脉曲张出血和少于 5 例的病例系列。检索结果产生了 1888 篇摘要。有 35 篇文章被选入最后的分析。
汇总患者总数为 927 例。栓塞的技术和临床成功率分别为 52-100%和 44-100%。原发性上消化道出血（PUGITH）、经乳头出血（TPH）和混合研究中汇总的平均技术/临床成功率分别为 84%/67%、93%/89%和 93%/64%。多器官衰竭、休克、皮质类固醇、输血和凝血障碍会对临床结果产生不利影响。出血的解剖来源和程序变量不影响结果。成功的栓塞可使存活率提高 13.3 倍。与手术的回顾性比较表明，尽管栓塞应用于合并症更多的老年人群，但死亡率和临床成功率相当。
栓塞对这一非常困难的患者群体是有效的，其结果与手术相似。
