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王永利
王永利 主任医师
上海市第六人民医院南院 介入科

非静脉曲张性上消化道出血的介入治疗---经动脉栓塞术

In adults with acute massive UGI bleeding the cause 
is duodenal ulcer in 30%-40% (Figure 1) and gastric ulcer 
in 20%-25%. In total, a significant mortality of 5%-15% 
has been unchanged during the last 30 years often related 
to co-morbidity。上海交通大学附属第六人民医院南院介入科王永利
成人急性上消化道大出血30%-40%的病因是十二指肠溃疡,20%-25%为胃溃疡。尽管医学已经有很大进展,但是在过去的30年里急性上消化道大出血的死亡率仍然达5%-15%。

 Transcatheter arterial embolization is a safe alternative to 
surgery for massive UGI bleeding that is refractory to en -
doscopic treatment. It can be performed with high techni -
cal and clinical success rates, and should be considered the 
salvage treatment of  choice in patients, especially those at 
high surgical risk. In many institutions transcatheter arte -
rial embolization is considered as the first-line intervention 
for  massive  UGI  bleeding  after  failed  endoscopic  treat -
ment。
经动脉介入栓塞治疗是内镜治疗无效的上消化道大出血的一种安全治疗方法,大部分可以替代外科手术。在很多医疗机构,经动脉介入栓塞术作为内镜治疗失败的上消化道大出血的首选治疗方法。
Both distal and proximal to the bleeding  part  of   the  vessel  (the  front-  and  backdoor)should be closed by embolization. If  dual supply to the
bleeding area is present, both arterial sources must be em -
bolized. Anastomoses from the superior mesenteric artery 
are not uncommon, and it is often necessary to embolize
both anterior and posterior gastroduodenal artery arcades, 
right gastroepiploic or superior pancreaticoduodenal ar -
teries.
介入治疗的要点是需要把出血的责任血管远端及近端都良好栓塞。假如双重供血存在的话,应该把供血动脉都良好栓塞。来自于肠系膜上动脉的侧枝并不少见,这时应该把胃十二指肠动脉前后弓、胃网膜右动脉或胰十二指肠动脉栓塞完全。
Embolization is a safe procedure in patients with non-
varicous UGI bleeding, and the number of  complications 
is  very  low  and  most  often  transient  in  relation  to  the 
treatment  (5%)。 The  described  complications  include 
access-site complications, dissection of  the target vessel, 
hepatic  or  splenic  infarction,  and  duodenal  stenosis.  A 
few cases of  intestinal ischaemia and necroses have also 
been described after embolization.
非静脉曲张性上消化道出血的动脉栓塞术的并发症非常低,而且常常是短暂的,发生率在5%左右。
包括穿刺道的并发症,靶血管的损伤,肝或脾的误栓。术后肠道缺血、坏死非常少见。

附1:90岁女性严重急性十二指肠溃疡出血的介入治疗DSA影像


附二:非静脉曲张性上消化道出血的介入治疗---经动脉栓塞术可能使用的栓塞材料



文章来源:Andersen PE, Duvnjak S. Endovascular treatment of nonvariceal 
acute  arterial  upper  gastrointestinal  bleeding. World  J  Radiol 
2010;  2(7):  257 -261  
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王永利
王永利 主任医师
上海市第六人民医院南院 介入科
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