儿童急性非静脉曲张性上消化道出血的经导管动脉栓塞术：一项单中心回顾性研究

Transcatheter arterial embolization for acute nonvariceal upper Gastrointestinal bleeding in children: a single-center retrospective study.

作者信息

Zhang Rong, Wang Shi Biao, He Jian Feng, Cai Tian Hong, Chen Yang Mei, Zhan Teng Hui

机构信息

Vascular Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, China.

Vascular Surgery, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Road, Gulou District, Fuzhou, Fujian Province, China.

出版信息

BMC Surg. 2025 Apr 19;25(1):168. doi: 10.1186/s12893-025-02908-7.

DOI:10.1186/s12893-025-02908-7

PMID:40253344

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12008960/

Abstract

OBJECTIVE

This study aims to provide a preliminary report on the outcomes of transcatheter arterial embolization (TAE) in pediatric patients with acute nonvariceal upper gastrointestinal bleeding (NVUGIB) to establish optimal practices for this intervention and explore its potential value in improving the management of pediatric patients.

METHODS

A retrospective analysis was conducted on children with NVUGIB who underwent TAE at a single institutional center between February 2022 and April 2024. Comprehensive data were collected, including patient demographics, clinical manifestations, diagnostic and therapeutic procedures, intraoperative findings, and follow-up outcomes.

RESULTS

A total of 266 cases with NVUGIB were admitted to the institutional center, with 14 cases (5.26%) undergoing TAE. There were 10 males and 4 females. The average age was 7.21 ± 4.77 years old, and the average hospital stay was 13.14 ± 8.69 days. Nine cases (64.29%) had hematochezia, 2 cases (14.29%) had hematemesis, 3 cases (21.42%) had both hematochezia and hematemesis. Six cases (42.86%) had no significant medical history, 3 cases (21.42%) had previous Helicobacter pylori infections, 2 cases (14.29%) had previous lymphomas, and 1 case (7.14%) each had immune disorders, gastroenteritis, and fever. The mean preoperative minimum hemoglobin level was 57.85 ± 21.25 g/L. All cases underwent gastroenteroscopy before TAE. Ten cases (71.43%) had duodenal bulb ulcers, 3 cases (21.43%) had duodenal ulcers, and 1 case (7.14%) had multiple ulcers in the gastric antrum. Bleeding was visible on endoscopy in 6 cases (Forrest Classification Ib,42.86%) (Table 2; Fig. 2), which were treated. All cases underwent TAE, and the timing of TAE averaged 4.29 ± 4.53 days. The responsible vessel was identified intraoperatively in all cases: gastroduodenal artery in 7 cases (50%) and pancreaticoduodenal artery in 7 cases (50%). A pseudoaneurysm was found in 2 cases (14.29%). Embolization of the responsible vessel was performed in all cases, using platinum coils alone in 8 cases (57.14%) and platinum coils combined with gelatin sponge in 6 cases (42.8%). All cases were followed up for an average of 13.69 ± 8.77 months, and no recurrence was detected.

CONCLUSION

TAE represents a promising intervention for pediatric patients with acute NVUGIB. Nevertheless, optimal timing, embolization techniques, and selection of embolizing agents necessitate further comprehensive investigation.

摘要

目的

本研究旨在提供关于经导管动脉栓塞术（TAE）治疗小儿急性非静脉曲张性上消化道出血（NVUGIB）结果的初步报告，以确立该干预措施的最佳实践，并探索其在改善小儿患者管理方面的潜在价值。

方法

对2022年2月至2024年4月在单一机构中心接受TAE的NVUGIB患儿进行回顾性分析。收集了全面的数据，包括患者人口统计学、临床表现、诊断和治疗程序、术中发现以及随访结果。

结果

该机构中心共收治266例NVUGIB病例，其中14例（5.26%）接受了TAE。男性10例，女性4例。平均年龄为7.21±4.77岁，平均住院天数为13.14±8.69天。9例（64.29%）有便血，2例（14.29%）有呕血，3例（21.42%）既有便血又有呕血。6例（42.86%）无明显病史，3例（21.42%）既往有幽门螺杆菌感染，2例（14.29%）既往有淋巴瘤，1例（7.14%）分别有免疫紊乱、胃肠炎和发热。术前平均最低血红蛋白水平为57.85±21.25g/L。所有病例在TAE前均接受了胃镜检查。10例（71.43%）有十二指肠球部溃疡，3例（21.43%）有十二指肠溃疡，1例（7.14%）胃窦有多发性溃疡。6例（Forrest分级Ib，42.86%）在内镜下可见出血（表2；图2），均接受了治疗。所有病例均接受了TAE，TAE的平均时间为4.29±4.53天。所有病例术中均确定了责任血管：胃十二指肠动脉7例（50%），胰十二指肠动脉7例（50%）。2例（14.29%）发现假性动脉瘤。所有病例均对责任血管进行了栓塞，8例（57.14%）单独使用铂圈，6例（42.8%）铂圈联合明胶海绵。所有病例平均随访13.69±8.77个月，未发现复发。