Department of Radiology, Kyungpook National University Hospital, 50 Samduk-Dong 2 Ga, Chung-Gu, Daegu 700-721, South Korea.
J Vasc Interv Radiol. 2011 Jun;22(6):879-83. doi: 10.1016/j.jvir.2011.01.453. Epub 2011 Apr 8.
To describe our experience with transcatheter n-butyl-2-cyanoacrylate (NBCA) embolization of refractory enteric or biliary fistulas.
Between March and December 2009, a retrospective analysis of patients with enteric or biliary fistulas revealed 11 cases unresponsive to drainage and treatment with NBCA (seven men; age range, 36-81 y). Fistula output ranged from 100 to 300 mL per day. Embolization was performed 20-55 days (mean, 32 d) after a fistula was noted on a radiograph of the abscess performed through a previously placed percutaneous drainage catheter. Digital subtraction imaging of the abscess via the percutaneous drainage catheter was used to show enteric or biliary communications and fistula tract. After the fistula tract was identified, it was cannulated under fluoroscopic guidance with a guide wire and a 5-F angiographic catheter. In embolization procedures, NBCA was deployed to fill and seal the entire tract and remnant abscess cavity.
In all patients, enteric or biliary fistula output ceased after one or two procedures without any complications. No recurrence was noted during follow-up of 9-17 months.
Persistent enteric or biliary fistulas can be treated successfully by transcatheter image-guided NBCA embolization. This may decrease the morbidity associated with prolonged external drainage and avert the need for surgery.
描述我们在经导管使用正丁基-2-氰基丙烯酸酯（NBCA）治疗难治性肠内或胆道瘘方面的经验。
2009 年 3 月至 12 月，对经引流和 NBCA 治疗无效的肠内或胆道瘘患者进行回顾性分析，共发现 11 例患者（7 名男性；年龄 36-81 岁）。瘘管每天的引流量为 100-300ml。在经先前放置的经皮引流导管进行的脓肿 X 线检查发现瘘管后 20-55 天（平均 32 天）进行栓塞。经皮引流导管对脓肿进行数字减影成像，以显示肠内或胆道的连通和瘘管通道。在瘘管通道被识别后，在透视引导下用导丝和 5-F 血管造影导管对其进行插管。在栓塞过程中，将 NBCA 注入以填充并密封整个瘘管和残余脓肿腔。
所有患者在 1-2 次治疗后，肠内或胆道瘘管引流量停止，无任何并发症。在 9-17 个月的随访中未发现复发。
经导管影像引导 NBCA 栓塞可成功治疗持续性肠内或胆道瘘，可减少长期外部引流引起的发病率，并避免手术需要。
