Woodhams Reiko, Nishimaki Hiroshi, Ogasawara Go, Fujii Kaoru, Yamane Takuro, Ishida Kenichiro, Kashimi Fumie, Matsunaga Keiji, Takigawa Masakazu
Department of Radiology, National Hospital Organization, Sagamihara National Hospital, 18-1, Sakuradai, Minami-ku, Sagamihara, Kanawaga, 252-0392 Japan.
Springerplus. 2013 Jul 26;2:344. doi: 10.1186/2193-1801-2-344. eCollection 2013.
To evaluate the feasibility and usefulness of imipenem/cilastatin sodium (IPM/CS) as an embolic agent for intestinal bleeding from neoplasms.
Seven patients who underwent 11 transarterial embolisations (TAEs) using IPM/CS as an embolic material for duodenal or small/large intestinal tumour bleeding from January 2004 to December 2011 were retrospectively evaluated. A mixture of IPM/CS and contrast medium was introduced through the microcatheter positioned at the feeding artery to the tumour until extravasation disappeared or stasis of blood flow to the tumour staining was observed.
Haemostasis was obtained in all patients. Therefore, the technical success rate was 100%. Rebleeding was observed in four patients. All of them underwent repeat TAE using IPM/CS, and haemostasis was obtained successfully. No complication was identified following laboratory and clinical examinations. No haemorrhagic death occurred. Haemorrhagic parameters, including blood haemoglobin and the amount of blood transfusion, improved after TAE.
The safety, feasibility, and effectiveness of TAE using IPM/CS as an embolic material for intestinal bleeding from neoplasms were suggested by this study. The mild embolic effect of IPM/CS may be adequate for oozing from tumours. Although rebleeding may occur after embolotherapy using IPM/CS, repeat embolisation is effective as treatment for rebleeding.
评估亚胺培南/西司他丁钠(IPM/CS)作为肿瘤性肠出血栓塞剂的可行性和实用性。
回顾性评估2004年1月至2011年12月期间7例患者,这些患者接受了11次经动脉栓塞术(TAE),使用IPM/CS作为十二指肠或小肠/大肠肿瘤出血的栓塞材料。将IPM/CS与造影剂的混合物通过置于肿瘤供血动脉的微导管注入,直至造影剂外渗消失或观察到肿瘤染色处血流停滞。
所有患者均实现止血。因此,技术成功率为100%。4例患者出现再出血。他们均接受了使用IPM/CS的重复TAE,且成功实现止血。实验室和临床检查未发现并发症。未发生出血性死亡。经TAE后,包括血红蛋白和输血量在内的出血参数有所改善。
本研究提示,使用IPM/CS作为肿瘤性肠出血栓塞材料进行TAE具有安全性、可行性和有效性。IPM/CS的轻度栓塞作用可能足以应对肿瘤渗血。尽管使用IPM/CS进行栓塞治疗后可能发生再出血,但重复栓塞作为再出血的治疗方法是有效的。