Self Duncan, Reece Mifanwy, Dilernia Shannon
Department of General Surgery, Central Coast Local Health District, Gosford, New South Wales, Australia.
Department of General Surgery, Concord Repatriation Hospital, Sydney, New South Wales, Australia.
ANZ J Surg. 2019 Apr;89(4):E109-E112. doi: 10.1111/ans.15064. Epub 2019 Mar 11.
Radiological angioembolization is an important strategy in management of acute colonic bleeding. Due to requirement for specialized interventional radiology, many hospitals rely on transfer for this service. This study aimed to identify patient and clinical factors associated with positive (blush) computed tomography mesenteric angiogram (CTMA) or need for invasive angiography. The secondary aim was to identify a patient population who may forego transfer and be safely managed in a regional centre.
All presentations to Central Coast Local Health District with colonic bleeding from June 2013-June 2017 were included. A guideline for transfer of patients with positive CTMA from Central Coast Local Health District to Royal North Shore Hospital had been established prior to the study period. Demographics, medical background, transfusion requirement, presentation details and mortality data were collected on all patients.
Of 2378 patients presenting with colonic bleeding, 71 of 247 patients investigated with CTMA had a blush. Forty-six patients were transferred to Royal North Shore Hospital. Of these, 28 proceeded to interventional angiography with 19 undergoing angioembolization. Acute transfusion ≥5 units (odds ratio 6.78, P < 0.01) was the only significant predictor of needing interventional angiography. There was no association between age, bleeding site (right or left), use of antiplatelet or anticoagulation, diverticular disease or chronic kidney disease and identification of arterial bleeding on interventional angiography. There was no mortality or significant procedure-related morbidity.
A patient's medical background demonstrates a lack of correlation to identification of active bleeding on interventional angiography. Patients requiring ≥5 units blood transfusion should be considered for transfer and interventional angiography.
放射血管栓塞术是急性结肠出血治疗中的一项重要策略。由于需要专业的介入放射学技术，许多医院依赖转诊来提供此项服务。本研究旨在确定与阳性（造影剂外溢）计算机断层扫描肠系膜血管造影（CTMA）或有创血管造影需求相关的患者及临床因素。次要目的是确定可能无需转诊并可在地区中心得到安全治疗的患者群体。
纳入2013年6月至2017年6月在中央海岸地方卫生区因结肠出血就诊的所有患者。在研究期之前，已制定了将CTMA阳性患者从中央海岸地方卫生区转诊至皇家北岸医院的指南。收集了所有患者的人口统计学资料、医疗背景、输血需求、就诊细节及死亡率数据。
在2378例因结肠出血就诊的患者中，247例接受CTMA检查的患者中有71例出现造影剂外溢。46例患者被转诊至皇家北岸医院。其中，28例接受了介入血管造影，19例接受了血管栓塞术。急性输血≥5单位（比值比6.78，P<0.01）是需要介入血管造影的唯一显著预测因素。年龄、出血部位（右侧或左侧）、抗血小板或抗凝药物的使用、憩室病或慢性肾脏病与介入血管造影时动脉出血的识别之间无关联。无死亡病例或与手术相关的严重并发症。
患者的医疗背景与介入血管造影时活动性出血的识别缺乏相关性。需要≥5单位输血的患者应考虑转诊并接受介入血管造影。
