胃癌相关性消化道出血介入治疗疗效分析

目的:观察介入导管栓塞术治疗胃癌相关性消化道出血的疗效、安全性及预后。方法:2012年1月至2016年12月期间对16例胃癌相关性消化道出血病例，行血管造影检查及介入导管栓塞止血术治疗，回顾性总结及分析止血效果与预后。结果:血管造影阳性率为87.5％(14／16)，栓塞止血技术成功率100%，一次栓塞临床成功率62.5%（10/16），二次栓塞临床成功率68.75%（11/16）。所有病例术后均未出现栓塞相关的胃肠道缺血坏死、穿孔等严重并发症。术后出血复发率37.5%（6/16），术后出血复发病例30天死亡率33.33%（2/6），60天死亡率83.33%（5/6）。总的1年生存率31.25%（5/16），3年生存率18.75%（3/16）。生存期超过1年的5例病人中，4例为外科术后病人。结论:介入导管栓塞术治疗胃癌相关性消化道出血安全、有效，尤其对内镜难治性出血、急性出血，具有显著的优势。介入术后复发出血病例预后差，短期内死亡率高。虽然栓塞术能暂缓出血情况，但临床相关的总体生存获益与后续有无外科手术切除的机会关系密切，不能外科手术切除者1年内死亡率高。

Efficacy analysis of transcatheter arterial angiography and embolization for gastric cancer associated gastrointestinal bleeding

Objective:To observe the efficacy,safety and prognosis of transcatheter arterial angiography and embolization in patients with gastric cancer associated gastrointestinal bleeding.Methods:Between January 2012 to December 2016,16 cases of gastric cancer associated gastrointestinal bleeding were treated with transcatheter arterial angiography and embolization,the hemostatic effect and prognosis were retrospectively summarized and analyzed.Results:Angiographic positive rate of bleeding was 87.5%(14/16),the technical success rate of embolization was 100%.The clinical success rate of first embolization was 62.5%(10/16),and the total clinical success rate was 68.75%(11/16) by the second embolization.No serious complications were encountered such as gastrointestinal ischemic necrosis or perforation associated embolization.The bleeding recurrence rate was 37.5%(6/16),the 30 days and the 60 days mortality rates of these patients were 33.33%(2/6) and 83.33%(5/6),respectively.The 1 year and 3 years survival rates were 31.25%(5/16) and 18.75%(3/16),respectively.In the 5 patients who survived for more than 1 years,there were 4 patients who had undergone surgery after interventional therapy.Conclusion:Transcatheter arterial embolization is a safe and effective method in the treatment of gastric cancer associated gastrointestinal bleeding,especially in the treatment of endoscopic intractable hemorrhage and acute bleeding.The prognosis of patients with recurrent hemorrhage is poor and the mortality is high in the short term.Although embolization may have temporized the acute bleeding episode,the associated clinical improvement may have afforded the opportunity for subsequent surgical resection,and those with unresection have a high mortality within 1 year.