内镜下金属夹在经导管动脉栓塞治疗复发性急性非静脉曲张性上消化道出血中的价值。
The value of endoscopically-placed metal clips for transcatheter arterial embolization in the treatment of recurrent acute non-variceal upper gastrointestinal bleeding.
机构信息
Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, GuoXue Xiang, Chengdu, 610041, People's Republic of China.
出版信息
BMC Gastroenterol. 2023 Nov 16;23(1):396. doi: 10.1186/s12876-023-03034-5.
OBJECTIVE
Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) is a common clinical emergency. Transcatheter arterial embolization (TAE) is usually used to locate the bleeding site and provide interventional embolization. During TAE, there is a low positive rate of angiography, and localization of the culprit vessel is difficult. The purpose of this study was to demonstrate the role of preplaced metal clips in TAE for ANVUGIB patients.
MATERIALS AND METHODS
Patients with ANVUGIB in whom bleeding sites were identified endoscopically and treated with TAE from January 1, 2005 to July 1, 2021 were retrospectively included. According to the presence or absence of preplaced metal clips, they were divided into two groups. The main outcome measurements included the clinical success rate and rebleeding rate. Secondary outcome measurements included the mortality rate and the need for surgery. Predictors of the clinical success rate were assessed with univariate analysis and multivariate analysis.
RESULTS
A total of 102 patients were included in this study, and all of them had undergone arterial embolization. There were 73 cases in the group with metal clips and 29 cases in the group without metal clips with consistent baseline information. The group with metal clips had a higher clinical success rate (82.2% vs. 45.0%, P < 0.001), lower rebleeding rate (8.2% vs 27.6%, P = 0.039) and additional surgery rate (11.0% vs 20.7%, P < 0.001) than the group without metal clips. In univariate analysis, ROCKALL score and preplaced metal clip marking were shown to affect clinical success rate. In multivariate analysis, metal clip marking was found to facilitate clinical success (OR = 3.750, 95CI = 1.456-9.659, P = 0.004).
CONCLUSION
In ANVUGIB patients, preplaced metal clips could improve the clinical success rate of TAE and reduce the mortality rate and the risk of rebleeding.
目的
急性非静脉曲张性上消化道出血（ANVUGIB）是一种常见的临床急症。经导管动脉栓塞术（TAE）通常用于定位出血部位并提供介入栓塞。在 TAE 过程中，血管造影的阳性率较低，且难以定位责任血管。本研究旨在展示预放置金属夹在 ANVUGIB 患者 TAE 中的作用。
材料和方法
回顾性纳入 2005 年 1 月 1 日至 2021 年 7 月 1 日期间经内镜确定出血部位并接受 TAE 治疗的 ANVUGIB 患者。根据是否预放置金属夹将患者分为两组。主要观察指标包括临床成功率和再出血率。次要观察指标包括死亡率和手术需求。采用单因素分析和多因素分析评估临床成功率的预测因素。
结果
本研究共纳入 102 例患者，均接受了动脉栓塞术。其中，73 例患者放置了金属夹，29 例患者未放置金属夹，两组患者的基线资料一致。放置金属夹组的临床成功率（82.2%比 45.0%，P<0.001）、再出血率（8.2%比 27.6%，P=0.039）和额外手术率（11.0%比 20.7%，P<0.001）均高于未放置金属夹组。单因素分析显示，ROCKALL 评分和预放置金属夹标记影响临床成功率。多因素分析显示，金属夹标记有助于临床成功（OR=3.750，95%CI=1.456-9.659，P=0.004）。
结论
在 ANVUGIB 患者中，预放置金属夹可提高 TAE 的临床成功率，降低死亡率和再出血风险。
Zotero 插件