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使用超选择性肠系膜栓塞作为急性下消化道出血的一线治疗方法。

The use of super-selective mesenteric embolisation as a first-line management of acute lower gastrointestinal bleeding.

作者信息

Soh Bryan, Chan Steven

机构信息

Department of Surgery, Western Health, 160 Furlong Road, Footscray, Melbourne, Victoria 3011, Australia.

Department of Surgery, Western Health, 160 Furlong Road, Footscray, Melbourne, Victoria 3011, Australia; The University of Melbourne, Melbourne Medical School - Western Precinct, Western Health, Sunshine Hospital 176, Furlong Road, St Albans, Melbourne, Victoria 3021, Australia.

出版信息

Ann Med Surg (Lond). 2017 Mar 23;17:27-32. doi: 10.1016/j.amsu.2017.03.022. eCollection 2017 May.

Abstract

INTRODUCTION

In this study, we aim to assess the efficacy and safety of digital subtraction angiography (DSA) and super-selective mesenteric artery embolisation in managing lower gastrointestinal bleeding (LGIB) at a multi-centre health service in Melbourne (Australia).

METHOD

A retrospective case series of patients with LGIB treated with superselective embolisation in our area health service. Patients with confirmed active LGIB, on either radionuclide scintigraphy (RS) or contrast-enhanced multi-detector CT angiography (CE-MDCT), were referred for DSA, and subsequently endovascular intervention. Data collected included patient characteristics; screening modality; bleeding territory; embolisation technique; technical and clinical success; short to mediumterm complications and mortality up to 30 days; and the need for surgery related to procedural failure or complications.

RESULTS

There were 55 hospital admissions with acute unstable lower gastrointestinal bleeding that were demonstrable on CE-MDCT or RS over a 30-month period (from 1 January 2014 to 30 June 2016). Of these, eighteen patients were embolised. Immediate haemostasis was achieved in all embolised cases. Eight patients (44%) had clinical re-bleeding postembolisation and warranted repeated imaging. However, only one case (5.6%) had active bleeding identified and was re-embolised. There was no documented case of bowel ischemia or ischemic-stricture and none progressed on to surgery. 30 day mortality was zero.

CONCLUSION

Super-selective mesenteric embolisation is a viable, safe and effective first line management for localised LGIB. Our results overall compare favourably with the published experiences of other institutions. It is now accepted first-line practice at our institution to manage localised LGIB with embolisation.

摘要

引言

在本研究中,我们旨在评估数字减影血管造影(DSA)和超选择性肠系膜动脉栓塞术在澳大利亚墨尔本的多中心医疗服务机构中治疗下消化道出血(LGIB)的疗效和安全性。

方法

对我们地区医疗服务机构中接受超选择性栓塞治疗的LGIB患者进行回顾性病例系列研究。经放射性核素闪烁扫描(RS)或对比增强多排CT血管造影(CE-MDCT)确诊为活动性LGIB的患者被转诊进行DSA检查,随后进行血管内介入治疗。收集的数据包括患者特征;筛查方式;出血部位;栓塞技术;技术和临床成功率;短期至中期并发症以及30天内的死亡率;以及因手术失败或并发症而需要手术的情况。

结果

在30个月期间(从2014年1月1日至2016年6月30日),有55例急性不稳定下消化道出血患者经CE-MDCT或RS检查确诊。其中,18例患者接受了栓塞治疗。所有栓塞病例均实现了即时止血。8例患者(44%)在栓塞后出现临床再出血,需要再次进行影像学检查。然而,仅1例(5.6%)被发现有活动性出血并再次接受了栓塞治疗。没有记录到肠道缺血或缺血性狭窄的病例,也没有患者需要进行手术。30天死亡率为零。

结论

超选择性肠系膜动脉栓塞术是治疗局限性LGIB的一种可行、安全且有效的一线治疗方法。我们的总体结果与其他机构发表的经验相比具有优势。目前,我们机构已将栓塞术作为治疗局限性LGIB的一线常规治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6409/5377484/d6cda18ac756/gr1.jpg

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