ACUTE LOWER GASTROINTESTINAL HEMORRHAGE - TREATMENT BY SUPERSELECTIVE EMBOLIZATION WITH POLYVINYL-ALCOHOL PARTICLES
ACUTE LOWER GASTROINTESTINAL HEMORRHAGE - TREATMENT BY SUPERSELECTIVE EMBOLIZATION WITH POLYVINYL-ALCOHOL PARTICLES
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DOI：
10.2214/ajr.159.3.1503016
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发表时间：
1992-09-01
影响因子：
5
通讯作者：
BURKE, TH
中科院分区：
文献类型：
--
作者：
GUY, GE;SHETTY, PC;BURKE, TH
目标。下消化道急性出血经导管栓塞术的主要风险是不可逆性肠缺血。目的：探讨超选择性聚乙烯醇颗粒栓塞术止血的有效性和安全性。所有临床或核素检查显示急性下消化道出血的患者均考虑进行超选择性栓塞术。9名血管造影显示下消化道活动性出血的患者接受了这一手术。超选择性栓塞术是通过3-France导管，使用100-590mU-m的聚乙烯醇颗粒完成的。栓塞后2~44天(平均11天)或临床评估(n=1)，通过内窥镜检查(n=7)或手术标本组织学评估(n=2)检查病变是否存在缺血。结果：该方法治疗的病变位于结肠(n=8)和空肠(n=1)。所有病例均立即止血。3例术后1~24天(平均9天)复发下消化道出血。其中两名患者接受了手术，一名患者成功地进行了第二次栓塞术。两名无症状的患者在内窥镜下被发现有小范围的缺血，仅累及粘膜。只有一名患者显示有严重的粘膜缺血；这在分布上累及结肠，这表明它不是由栓塞引起的。结论：10例使用聚乙烯醇颗粒的超选择性栓塞术成功地控制了9名患者的下消化道出血。无一例发生肠梗死，仅2例经内窥镜证实为无症状性黏膜缺血。
OBJECTIVE. The major risk of transcatheter embolotherapy for acute hemorrhage in the lower gastrointestinal tract is irreversible intestinal ischemia. The authors studied the efficacy and safety of superselective transcatheter embolization with polyvinyl alcohol particles in arresting acute hemorrhage in the lower gastrointestinal tract.SUBJECTS AND METHODS. All patients with clinical or scintigraphic evidence of acute hemorrhage in the lower gastrointestinal tract were considered for superselective embolization. The nine patients with angiograms that showed active hemorrhage in the lower gastrointestinal tract underwent the procedure. Superselective embolization was done through a 3-French catheter and was accomplished by using 100- to 590-mu-m polyvinyl alcohol particles. The segments of the intestinal tracts involved in the embolizations were examined for the presence of ischemia by endoscopy (n = 7) or histologic evaluation of a surgical specimen (n = 2) 2-44 days (mean, 11 days) after embolization or by clinical evaluation (n = 1).RESULTS. The lesions treated by this method were located in the colon (n = 8) and jejunum (n = 1). Immediate hemostasis was achieved in every case. Three patients had recurrent lower gastrointestinal hemorrhage 1-24 days (mean, 9 days) after initial embolization. Two of these patients had surgery, while one had a successful second embolization. Two asymptomatic patients were found endoscopically to have small areas of ischemia involving only the mucosa. Only one patient was shown to have severe mucosal ischemia; this involved the colon in a distribution that suggested it was not caused by the embolization.CONCLUSION. Ten superselective embolization procedures that used polyvinyl alcohol particles successfully controlled hemorrhage in the lower gastrointestinal tract in nine patients. In no case was intestinal infarction induced by the procedure, and only two endoscopically proved cases of asymptomatic mucosal ischemia occurred.