Glue embolization for gastroduodenal ulcer bleeding: contribution to hemodynamics and healing process
Glue embolization for gastroduodenal ulcer bleeding: contribution to hemodynamics and healing process
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DOI：
10.1177/0284185113484644
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发表时间：
2013-10-01
期刊：
影响因子：
1.3
通讯作者：
Kumita, S.
中科院分区：
文献类型：
--
作者：
Mine, Takahiko;Murata, S.;Kumita, S.
背景：虽然已经提出胶栓塞后肠缺血事件的发病率，但胶与缺血之间的因果关系尚未明确确立。目的：评价氰基丙烯酸酯正丁酯（NBCA-TAE）经导管动脉栓塞治疗上消化道出血（GIH）的有效性和安全性。材料与方法：2006年10月至2012年10月，21例上GIH患者接受了NBCA-TAE手术，并在随访30天内获得内镜数据。比较NBCA-TAE前后的休克指数，以确定血流动力学的变化。通过随访内窥镜检查评估，到Forrest III型的天数作为愈合过程的指标。其他临床结果包括开始摄入和出院天数。结果：治疗胃溃疡16例，十二指肠溃疡5例，归为Forrest I型。所有患者均立即止血，随访期间无再出血。休克指数由NBCA-TAE前（0.99 +/- 0.076）至即刻（0.67 +/- 0.038）显著改善（P < 0.001）。所有患者均观察到连续的粘膜愈合过程，到Forrest III型的天数为9.6 +/- 7.1。开始摄食和出院天数分别为9.0 +/- 4.5天和15 +/- 7.7天。结论：NBCA-TAE对胃十二指肠粘膜血流动力学和愈合过程的影响是一种有效、安全的控制非静脉曲张上GIH的方法。
Background: Although the morbidity of bowel ischemic events after glue embolization has been suggested, a causal relationship between glue and ischemia has not been clearly established.Purpose: To evaluate the efficiency and safety of transcatheter arterial embolization with n-butyl cyanoacrylate (NBCA-TAE) for upper gastrointestinal hemorrhage (GIH).Material and Methods: Between October 2006 and October 2012, 21 patients with upper GIH underwent NBCA-TAE, and endoscopic data were obtained within 30 days of follow-up. Shock index prior to and immediately after NBCA-TAE were compared to determine changes in hemodynamics. Days to Forrest type III, as assessed by follow-up endoscopy, was used as an indicator of the healing process. Other clinical outcomes included days for starting ingestion and for hospital discharge.Results: Sixteen gastric and five duodenal ulcers, classified into Forrest type I, were treated. Immediate hemostasis was achieved in all the patients, and no re-bleeding occurred within the follow-up period. Shock index significantly (P < 0.001) improved from before (0.99 +/- 0.076) to immediately after NBCA-TAE (0.67 +/- 0.038). Sequential mucosal healing processes were observed in all the patients, and the number of days to Forrest type III was 9.6 +/- 7.1. The number of days for starting ingestion and hospital discharge was 9.0 +/- 4.5 and 15 +/- 7.7 days, respectively.Conclusion: NBCA-TAE is an effective and safe method for the control of nonvariceal upper GIH, in terms of contribution to hemodynamics and healing process of the gastroduodenal mucosa.