小肠出血数字减影血管造影27例分析

The clinical value of digital subtraction angiography in small intestinal hemorrhage

目的探讨数字减影血管造影(DSA)在小肠出血中的临床价值。方法对27例经手术和病理检查证实为小肠出血的DSA影像资料进行回顾性分析,所有病例均用Seldinger法行肠系膜上动脉插管造影,其中2例用明胶海绵颗粒超选栓塞。结果 DSA显示出血直接征像8例,出血间接征像10例,同时具有直接征像和间接征像5例,无阳性发现4例。DSA发现小肠出血阳性率为85%,阳性病例与手术病理诊断符合率为83%,定位诊断符合率为100%。小肠出血病因分别为肿瘤性病变11例(其中平滑肌瘤7例,平滑肌肉瘤1例,间质瘤2例,小肠癌1例),小肠憩室4例,血管病变5例,肠道吻合术后2例,炎症1例,阴性4例。超选栓塞2例,随访均未出现小肠坏死或小肠出血。结论 DSA对小肠出血的定位、定性诊断有肯定的价值,有望对小肠出血的诊断和治疗的临床决策提供帮助。

Objective To discuss the clinical value of digital subtraction angiography（DSA） in small intestinal hemorrhage （SIH）. Methods The DSA data of 27 ＂cases of SIH were analyzed retrospectively. The cases of bleeding in all the cases were confirmed by surgery and pathology. They were performed angiography with Seldinger＇s technique through superior mesenteric artery. 2 cases embolized partial superior mesenteric artery with particulate gelatin sponge. Results 8 cases demonstrated direct signs of hemorrhage, 10 cases of indirect signs of hemorrhage and 5 cases with both of the signs. 4 cases were negative sign. The causes of small intestinal hemorrhage was 11 cases Of tumor（7 cases eiomyomas, 1 caseseiomyosarcomas, 2 cases interstitial tumor, 1 cases small intestinal cancer）,including 4 cases of small intestinal diverticulum,5 cases of vasculopathy,2 cases of postintestinal anastomoses, and 1 case of inflammation. The positive rate of hemorrhage was 85 %. The coincide rate of positive cases with pathology .was 83% and the diagnostic accuracy of location was 100%. Follow-up of two embolized patients did not find small iptestinal necrosis and hemorrhage. Conclusion DSA is very helpful for determining the location and character of in SIH,hoping a rational approach to patients with SIH according to the clinical presentation presented herein.