Embolization as a first approach with endoscopically unmanageable acute nonvariceal gastrointestinal hemorrhage
Embolization as a first approach with endoscopically unmanageable acute nonvariceal gastrointestinal hemorrhage
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DOI：
10.1148/radiology.218.3.r01mr05739
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发表时间：
2001-03-01
期刊：
影响因子：
19.7
通讯作者：
Kunnen, M
中科院分区：
文献类型：
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作者：
Defreyne, L;Vanlangenhove, P;Kunnen, M
目得：为了确定内镜下无法处理的非静脉曲张性消化道出血（GIH）栓塞的技术和临床结果：回顾性研究了91例急性非静脉曲张性GIH行动脉造影的40例栓塞的结果。胃肠道出血为上、下或经乳头（胆道出血、胰管出血）。临床参数和栓塞数据进行了评估，临床成功和住院survival.Results：技术成功（出血目标断流术），实现了所有患者，除了一个上胃肠道出血（39 [98%]的40例患者）。无肠道并发症发生。观察到1例部分肝叶和1例部分脾梗死。39例患者中有5例（13%）在3天内再次流血的;所有患者均出现上胃肠道出血（P = 0.049）。39例患者中有32例（82%）获得临床成功（30天后无再出血）。19例上胃肠道出血患者中有13例（68%）临床成功，11例下胃肠道出血患者中有10例（91%）临床成功，所有经乳头胃肠道出血患者临床成功（P = 0.084）。死亡率为28%（40例患者中的11例），平均分布于上、下和经乳头GIH（P = 0.87）。失血（血红蛋白水平< 80 g/L，P = 0.041）、使用浓缩红细胞（P = 0.049）和新鲜冷冻血浆（P = 0.006）、休克（P = 0.047）和皮质类固醇使用（P = 0.036）与再出血有关。栓塞前休克（P = 0.039）和使用新鲜冷冻血浆（P = 0.003）和再出血（P = 0.012）、凝血功能障碍（P = 0.007）和栓塞后需要手术（P = 0.03）与死亡率密切相关。结论：栓塞是内镜检查后低位和经乳头胃肠道出血的有效首选方法;对高位胃肠道出血效果较差。
PURPOSE: To determine technical and clinical results of embolization of endoscopically unmanageable nonvariceal gastrointestinal hemorrhage (GIH).MATERIALS AND METHODS: Results of 40 embolizations in 91 patients who underwent arteriography for acute nonvariceal GIH were retrospectively studied. GIH was upper, lower, or transpapillar (hemobilia, pancreatic duct bleeding). Clinical parameters and embolization data were assessed for clinical success and in-hospital survival.RESULTS: Technical success (bleeding target devascularization) was achieved in all patients except one with upper GIH (39 [98%] of 40 patients). No bowel complications occurred. One partial liver lobe and one partial spleen infarction were noted. Five (13%) of 39 patients bled again within 3 days; all had upper GIH (P = .049). Clinical success (no rebleeding after 30 days) was achieved in 32 (82%) of 39 patients. Clinical success occurred in 13 (68%) of 19 patients with upper GIH, in 10 (91%) of 11 with lower GIH, and in all with transpapillar GIH (P = .084). Mortality rate was 28% (11 of 40 patients), equally spread over upper, lower, and transpapillar GIH (P = .87). Blood loss (hemoglobin level < 80 g/L, P = .041), use of packed cells (P = .049) and fresh frozen plasma (P = .006); shock (P = .047); and corticosteroid use (P = .036) were related to rebleeding. Shock (P = .039) and use of fresh frozen plasma (P = .003) before embolization and rebleeding (P = .012), coagulopathy (P = .007), and need for surgery (P = .03) after embolization were strongly correlated with mortality.CONCLUSION: Embolization is an effective first approach with lower and transpapillar GIH after endoscopy; it was less effective with upper GIH.