Transarterial Embolization (TAE) in the Management of Life-Endangering Intrapelvic Hemorrhage and Neoplasms

經動脈栓塞術於骨盆腔內併有生命垂危之大出血及腫瘤的治療硏究

錢本文(Poon-Ung Chieng) ； 曾旭明(Yuk-Ming Tsang) ； 張賴昇平(Sheng-Pyng Changlai) ； 田德揚(Robert Deryang Tien) ； 龔國倫(Kou-Luon Kung) ； 黃國茂(Kou-Mou Huang) ； 徐劍耀(Chien-Yao Hsu)

《中華放射線醫學雜誌》 15卷3期 (1990/09) Pp. 157-166

摘要

骨盆腔動脈栓塞術為治療具有生命危險之大量骨盆腔出血及骨盆腔腫瘤之一種療法。本研究一共於22位患者（10男，12女）進行了34次骨盆腔內栓塞術，總共栓塞了60條動脈。患者平均年齡為43.3歲。本研究中栓塞術之最重要適應症為膀胱(n=6)及陰道(n=8)出血不止，以及8例骨盆腔內腫瘤之治療。關於各種栓塞物質之選擇，則端視栓塞之目的而定；一般而言粉狀或粒狀止血綿常用於出血之患者，而Ivalon及油性碘化學治療則被應用於腫瘤治療。
骨盆腔內栓塞術依常規皆須要做雙側性骼內動脈栓塞術，但由本研究中發現7例只須做單側栓塞即可達到療效，其中3例為單側骨盆腔內出血，4例為腫瘤之治療。此外吾人發現有5例骨盆腔內出血點確定後之案例可實施骼內動脈之前分枝超選擇性之栓塞術。如此不但可馬上收止血之效，更可將併發症減少致最少。由吾人之結果看來，骨盆腔內栓塞術之安全性很高只有1例發生較嚴重之併發症，該患者由屍體解剖發覺患者整個胝骨神經叢已被癌細胞所浸潤，故栓塞後，骼骨神經叢症候群加速惡化，併有大小便失禁，兩腿癱瘓。
有關栓塞物質之選擇是非常重要，吾人建議下例三種病理生理學狀況所應作之選擇標準：
(1)無腫瘤之急性出血應選擇可分解性栓塞物質如粉狀或粒狀止血綿，俟於止血之後便可分解以不致於引起組織壞死。
(2)因腫瘤而出血者應使用末端栓塞物質如Ivaion並可有或無附加油性碘化學治療。
(3)因假性血管瘤破裂而有生命危險之大量出血者應使用效果快且佳之永久性栓塞物質如不銹鋼絲。
由本研究之結果可以肯定地認為骨盆腔內動脈栓塞術為治療骨盆腔內有生命危險之大量出血不止患者的最佳治療法至於腫瘤之療效則不甚理想。

並列摘要

Intrapelvic hemorrhage can be life-endangering and pelvic neoplasms may be unresectable. We assessed our experience in transarterial embolization (TAE) of 60 arteries in 22 patients to determine the efficacy and safety of this method in treating the aforementioned conditions and to identify the optimal embolic materials to use. In addition, we also evaluated the adequacy of unilateral and superselective embolization of the anterior branch of hypogastric artery. We treated 22 patients (10 men and 12 women, mean age 43.3 years); 14 had intractable intrapelvic hemorrhage (6 of bladder origin and 8 of vaginal origin); the other 8 had pelvic neoplasms. The embolic materials used were Gelfoam powder and pieces, steel coil, Ivalon, and lipiodolized chemotherapeutic agents. We found that immediate hemostasis was achieved in all cases of hemorrhage except in 1 case with recurrent bleeding, but neoplasms failed to respond. Finally, we found that unilateral (n=3) and superselective embolization of the anterior branch of hypogastric artery (n=5) was adequate and effective when the bleeding site could be identified. There was only one case of major complication: a women who developed gradual onset of sacral plexus syndrome and autopsy disclosed cancerous infiltration of her entire sacral plexus. The choice of embolic materials is crucial. It should be optimal to have decomposable embolic materials such as gelfoam powder or pieces for acute hemorrhage without neoplasms; Ivalon without or with a lipiodolized chemotherapeutic agent for hemorrhage from neoplasms; and a permanent material such as steel coil for massive life-endangering hemorrhage from ruptured pseudoaneurysm of major pelvic arteries. We conclude that pelvic TAE is effective and safe, and is indeed the method of treating intractable intrapelvic hemorrhage from acute non-tumor and tumor origin, but it is not effective for treating pelvic neoplasms.

並列關鍵字

arteries ； hypogastric ； embolism ； therapeutic ； hemorrhage ； tumor