Shi Yadong, Chen Liang, Zhao Boxiang, Huang Hao, Lu Zhaoxuan, Su Haobo
Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, PR China.
Acta Radiol. 2022 Mar;63(3):360-367. doi: 10.1177/0284185121992971. Epub 2021 Feb 9.
Massive hemobilia is a life-threatening condition and therapeutic challenge. Few studies have demonstrated the use of N-butyl cyanoacrylate (NBCA) for massive hemobilia.
To investigate the efficacy and safety of transcatheter arterial embolization (TAE) using NBCA Glubran 2 for massive hemobilia.
Between January 2012 and December 2019, the data of 26 patients (mean age 63.4 ± 12.6 years) with massive hemobilia were retrospectively evaluated for TAE using NBCA. The patients' baseline characteristics, severities of hemobilia, and imaging findings were collected. Emergent TAE was performed using 1:2-1:4 mixtures of NBCA and ethiodized oil. Technical success, clinical success, procedure-related complications, and follow-up outcomes were assessed.
Pre-procedure arteriography demonstrated injuries to the right hepatic artery (n = 24) and cystic artery (n = 2). Initial coil embolization distal to the lesions was required in 5 (19.2%) patients to control high blood flow and prevent end-organ damage. After a mean treatment time of 11.2 ± 5.3 min, technical success was achieved in 100% of the patients without non-target embolization and catheter adhesion. Clinical success was achieved in 25 (96.2%) patients. Major complications were noted in 1 (3.8%) patient with gallbladder necrosis. During a median follow-up time of 16.5 months (range 3-24 months), two patients died due to carcinomas, whereas none of the patients experienced recurrent hemobilia, embolic material migration, or post-embolization complications.
NBCA embolization for massive hemobilia is associated with rapid and effective hemostasis, as well as few major complications. This treatment modality may be a promising alternative to coil embolization.
大量胆道出血是一种危及生命的疾病，也是治疗上的挑战。很少有研究证明使用氰基丙烯酸正丁酯（NBCA）治疗大量胆道出血。
探讨使用Glubran 2型NBCA进行经导管动脉栓塞术（TAE）治疗大量胆道出血的有效性和安全性。
回顾性评估2012年1月至2019年12月期间26例大量胆道出血患者（平均年龄63.4±12.6岁）接受TAE使用NBCA的情况。收集患者的基线特征、胆道出血严重程度和影像学检查结果。使用1:2至1:4的NBCA与碘化油混合物进行急诊TAE。评估技术成功率、临床成功率、与操作相关的并发症和随访结果。
术前血管造影显示右肝动脉损伤24例，胆囊动脉损伤2例。5例（19.2%）患者需要在病变远端先行弹簧圈栓塞以控制高血流量并防止终末器官损伤。平均治疗时间为11.2±5.3分钟后，100%的患者获得技术成功，无异位栓塞和导管粘连。25例（96.2%）患者获得临床成功。1例（3.8%）患者出现胆囊坏死这一主要并发症。中位随访时间为16.5个月（3至24个月），2例患者因癌症死亡，而无患者出现复发性胆道出血、栓塞材料移位或栓塞后并发症。
使用NBCA栓塞治疗大量胆道出血可实现快速有效的止血，且主要并发症较少。这种治疗方式可能是弹簧圈栓塞的一种有前景的替代方法。
