“三明治法”栓塞治疗急性十二指肠溃疡出血的疗效分析

发布时间：2018-05-22 09:06

本文选题：十二指肠溃疡 + 出血　；参考：《临床放射学杂志》2015年10期

【摘要】：目的评估"三明治法"栓塞治疗急性十二指肠溃疡出血的临床疗效。方法 2008年10月至2014年4月间,30例内镜证实的十二指肠活动性溃疡出血且止血失败的患者,采用明胶海绵、钢圈结合的"三明治法"栓塞胃十二指肠动脉。治疗方法为先经导管置入弹簧圈栓塞胃网膜右动脉起始段,再后撤微导管以弹簧圈及明胶海绵颗粒栓塞胃十二指肠动脉出血分支、周边分支,最后以弹簧圈栓塞胃十二指肠动脉主干,即所谓"三明治法",腹腔干及肠系膜上动脉造影显示栓塞部位覆盖内镜指示的出血部位,视为栓塞成功。术后对所有病例进行为期6~72个月的追踪随访,记录技术成功率、一次栓塞成功率、二次栓塞成功率、再出血率、死亡率。结果 21例动脉造影可见对比剂外溢征象(70%),9例未见对比剂外溢直接出血征象(30%),30例患者成功行32次栓塞,栓塞技术成功率100%,一次栓塞成功率83.3%(25/30),5例(16.7%)再出血中2例行二次栓塞出血停止,二次栓塞成功率90.0%(27/30),1例转外科手术出血停止(3.3%),2例因出血并发多器官功能衰竭死亡(6.7%),栓塞止血成功的27例经内科治疗后,随访6~72个月未见复发出血。1例患者在动脉栓塞术后12 h出现无症状性胰酶增高,60 h后恢复正常(3.3%),未出现肠缺血坏死及肠道狭窄。结论 "三明治法"栓塞治疗十二指肠溃疡出血安全、有效。
[Abstract]:Objective to evaluate the clinical efficacy of sandwich embolization in the treatment of acute duodenal ulcer hemorrhage. Methods from October 2008 to April 2014, 30 patients with bleeding and hemostatic failure of duodenal active ulcer confirmed by endoscopy were embolized by gelatin sponge, steel ring and sandwich method. The treatment was performed by inserting coils into the beginning segment of right gastroepiploic artery, then removing microcatheters to embolize the bleeding branches of gastroduodenal artery with coils and gelatin sponge particles. Finally, the main gastroduodenal artery was embolized with coils, the so-called "sandwich method". The endoscopically indicated bleeding was covered by abdominal trunk and superior mesenteric arteriography, which was regarded as successful embolization. All the patients were followed up for 6 ~ 72 months. The success rate of technique, one embolization, two embolization, the rate of rebleeding and the mortality were recorded. Results in 21 cases of arteriography, 30 cases were successfully embolized by 32 times of embolization. The successful rate of embolization was 100%, the success rate of one embolization was 83.3%, and the success rate of one embolization was 83.3%. The success rate of secondary embolization was 90.0% and 27 / 30% respectively. One case of conversion to surgery with bleeding stopped at 3.3% and 2 cases died of multiple organ failure because of bleeding. 27 cases of successful embolization and hemostasis were treated by internal medicine. No recurrent hemorrhage was found in all patients during 6 ~ 72 months follow-up. The asymptomatic elevation of trypsin was found at 12 hours after arterial embolization and returned to normal at 60 hours. There was no intestinal ischemic necrosis or intestinal stenosis. Conclusion Sandwich embolization is safe and effective in the treatment of duodenal ulcer bleeding.
【作者单位】：广州军区广州总医院介入治疗中心;
【分类号】：R573.1

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