Köhler Gernot, Koch Oliver Owen, Antoniou Stavros A, Mayer Franz, Lechner Michael, Pallwein-Prettner Leo, Emmanuel Klaus
Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria,
World J Surg. 2014 Sep;38(9):2258-66. doi: 10.1007/s00268-014-2570-7.
Gastrointestinal and abdominal bleeding can lead to life-threatening situations. Embolization is considered a feasible and safe treatment option. The relevance of surgery has thus diminished in the past. The aim of the present study was to evaluate the role of surgery in the management of patients after embolization.
We performed a retrospective single-center analysis of outcomes after transarterial embolization of acute abdominal and gastrointestinal hemorrhage between January 2009 and December 2012 at the Sisters of Charity Hospital, Linz. Patients were divided into three groups, as follows: upper gastrointestinal bleeding (UGIB), lower gastrointestinal bleeding (LGIB), and abdominal hemorrhage.
Fifty-four patients with 55 bleeding events were included. The bleeding source could be localized angiographically in 80 %, and the primary clinical success rate of embolization was 81.8 % (45/55 cases). Early recurrent bleeding (<30 days) occurred in 18.2 % (10/55) of the patients, and delayed recurrent hemorrhage (>30 days) developed in 3.6 % (2/55). The mean follow-up was 8.4 months, and data were available for 85.2 % (46/54) of the patients. Surgery after embolization was required in 20.4 % of these patients (11/54). Failure to localize the bleeding site was identified as predictive of recurrent bleeding (p = 0.009). More than one embolization effort increased the risk of complications (p = 0.02) and rebleeding (p = 0.07).
Surgery still has an important role after embolization in patients with gastrointestinal and abdominal hemorrhage. One of five patients required surgery in cases of early and delayed rebleeding or because of ischemic complications (2/55 both had ischemic damage of the gallbladder) and bleeding consequences.
胃肠道及腹部出血可导致危及生命的情况。栓塞术被认为是一种可行且安全的治疗选择。因此，过去手术的相关性有所降低。本研究的目的是评估手术在栓塞术后患者管理中的作用。
我们对2009年1月至2012年12月在林茨慈善医院进行的急性腹部和胃肠道出血经动脉栓塞术后的结果进行了回顾性单中心分析。患者分为三组，如下：上消化道出血（UGIB）、下消化道出血（LGIB）和腹部出血。
纳入了54例患者，共发生55次出血事件。80%的出血源可通过血管造影定位，栓塞术的主要临床成功率为81.8%（45/55例）。18.2%（10/55）的患者发生早期再出血（<30天），3.6%（2/55）的患者发生延迟性再出血（>30天）。平均随访时间为8.4个月，85.2%（46/54）的患者有可用数据。这些患者中有20.4%（11/54）在栓塞术后需要手术。未能定位出血部位被确定为再出血的预测因素（p = 0.009）。多次栓塞会增加并发症风险（p = 0.02）和再出血风险（p = 0.07）。
对于胃肠道和腹部出血患者，栓塞术后手术仍具有重要作用。在早期和延迟再出血或因缺血性并发症（2/55均有胆囊缺血性损伤）及出血后果的情况下，五分之一的患者需要手术。
