消化道大出血的急诊血管造影与介入治疗

Emergency angiography and treatment in massive bleeding of digestive tract with interventional therapy

目的:探讨消化道大出血的急诊血管造影与介入治疗的临床价值。方法:收集29 例消化道大出血患者,采用Seldinger技术经股动脉穿刺插管行选择性血管造影,根据出血病因及出血部位分别行出血动脉的栓塞或缩血管药物局部灌注治疗,对不能明确出血病因及出血部位者行试验性栓塞和/或灌注治疗。结果:本组血管造影有阳性发现21 例,主要表现为肿瘤性病变5 例、血管性病变5例、造影剂外溢和滞留11例。栓塞治疗18例,即刻止血率94.4%(17/18);灌注缩血管药物6例,即刻止血4 例;试验性栓塞和/或灌注治疗5 例,即刻止血2 例。结论:消化道大出血在急诊血管造影的基础上行选择性出血动脉栓塞或缩血管药物灌注治疗是安全有效的止血措施,血管造影对出血病因及出血部位的检出具有重要意义。

Objective: To investigate the clinical value of emergency angiography and interventional therapy in the treament of massive digestive tract bleeding.Methods:Twenty-nine cases with massive bleeding of the digestive tract were included in this study.The number of male and femal ecases was 22 and 7,respectively, with a mean age of 5 0.8 years(22~68 years).With the Seldinger technique the catheter was introduced and selective angiography was followed. Accoding to the causes and sites of hemorrhage embolization or vasoconstrictor perfusion of the bleeding arteries were performed. For those cases with bleeding of unknow reasons trial embolization and vasoconstrictor perfusion were carried out. Results:Abnormal angiographic signs were detected in 21 cases which included neoplastic lesions in 5 cases,vascular lesions in 5 cases and contrast flux or retention in 11 cases. Embolizing therapy was performed in 18 cases with an immediate hemostatic rate of 94.4%(17/18). In 6 cases the vasoconstrictor agents were used and the hemorrhage stopped immediately in 4 cases. In 5 cases who accepted trial embolization and/or perfusion the bleeding ceased in two cases.Conclsion:In massive digestive tract bleeding emergency angiography and selective arterial cmbolization as well as vasoconstrictor perfusion are safe and effective hemostatic measures. Selective angiography plays an important role in detecting the causee and the sites of the bleeding.