Loffroy Romaric, Lin MingDe, Thompson Carol, Harsha Amith, Rao Pramod
Russell H Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Acta Radiol. 2011 Dec 1;52(10):1076-82. doi: 10.1258/ar.2011.110344. Epub 2011 Oct 17.
Although some authors have advocated the practice of arterial embolization for angiographically negative acute hemorrhage from gastroduodenal ulcers, this technique remains controversial.
To compare the results of arterial embolization for bleeding (BU) and non-bleeding (NBU) gastroduodenal ulcers.
Transcatheter embolization was performed in 57 patients (39 men, 18 women, mean age 69.8 years) who experienced acute bleeding from gastroduodenal ulcers. At the time of embolization active contrast extravasation was seen in 36 of 57 patients, while in the remaining 21 patients embolization was based on endoscopic findings. Patient demographics, clinical success, need for re-intervention secondary to re-bleeding, and 30-day complication and mortality rates were reviewed and compared between the two groups by using statistical analyses.
In the BU group, the gastroduodenal artery (GDA) was embolized in 31 patients (86.1%), the left gastric artery (LGA) in three patients (8.3%), and the left gastroepiploic artery (LGEA) in two patients (5.6%). In the NBU group, the GDA was embolized in 18 patients (85.7%), and the LGA in three patients (14.3%). Clinical success (61.9 vs. 75.0%, P = 0.30), need for re-intervention (38.1 vs. 27.8%, P = 0.42), and 30-day complication (9.5 vs. 5.6%, P = 0.57), and mortality (28.6 vs. 25%, P = 0.77) rates were not statistically different between the two groups. Embolization in patients in NBU group did not have impact on clinical success (OR, 0.54; 95%CI, 0.17-1.72; P = 0.30).
Arterial embolization in patients with angiographically NBU is as safe and effective as embolization in patients with BU.
尽管一些作者主张对血管造影阴性的胃十二指肠溃疡急性出血进行动脉栓塞治疗，但该技术仍存在争议。
比较出血性（BU）和非出血性（NBU）胃十二指肠溃疡动脉栓塞治疗的结果。
对57例（39例男性，18例女性，平均年龄69.8岁）胃十二指肠溃疡急性出血患者进行经导管栓塞治疗。栓塞时，57例患者中有36例可见活动性造影剂外渗，其余21例患者的栓塞基于内镜检查结果。通过统计分析对两组患者的人口统计学特征、临床成功率、因再出血而需要再次干预的情况以及30天并发症和死亡率进行回顾和比较。
在出血性溃疡组中，31例患者（86.1%）栓塞了胃十二指肠动脉（GDA），3例患者（8.3%）栓塞了胃左动脉（LGA），2例患者（5.6%）栓塞了胃网膜左动脉（LGEA）。在非出血性溃疡组中，18例患者（85.7%）栓塞了GDA，3例患者（14.3%）栓塞了LGA。两组之间的临床成功率（61.9%对75.0%，P = 0.30）、再次干预的必要性（38.1%对27.8%，P = 0.42）、30天并发症（9.5%对5.6%，P = 0.57）和死亡率（28.6%对25%，P = 0.77）差异无统计学意义。非出血性溃疡组患者的栓塞对临床成功率没有影响（OR，0.54；95%CI，0.17 - 1.72；P = 0.30）。
血管造影显示为非出血性溃疡患者的动脉栓塞与出血性溃疡患者的栓塞一样安全有效。
