不明原因消化道出血的DSA和介入治疗

DSA and Interventional Therapy in Obscure Gastrointestinal Bleeding

背景：不明原因消化道出血的诊断和治疗是临床的一大难题．数字减影血管造影（DSA）对不明原因消化道出血的诊断具有独到的优势。目的：探讨DSA和介入治疗对不明原因消化道出血的诊断和治疗价值。方法：对2008年9月～2010年10月哈尔滨医科大学附属第四医院收治的82例不明原因消化道出血患者行DSA．发现可疑病变行动脉栓塞或药物灌注等介入治疗。结果：DSA阳性者64例，诊断率78．0％，其中小肠出血58例，术后吻合口出血6例。22例患者表现为造影剂外溢的出血直接征象，42例表现为间接征象；26例（40．6％）患者的出血原因为小肠肿瘤，18例为憩室（28．1％）。17例患者（16例动脉栓塞、1例药物灌注）接受介入治疗，取得良好的疗效。结论：DSA能明确不明原因消化道出血的部位和病因。并能对部分患者行介入治疗．具有较高的诊断和治疗价值。

Background： Diagnosis and treatment of obscure gastrointestinal bleeding is a difficult problem in clinics, and digital subtraction angiography （DSA） has its unique advantages in the diagnosis of obscure gastrointestinal bleeding. Aims： To investigate the diagnostic and therapeutic values of DSA and interventional therapy in obscure gastrointestinal bleeding. Methods： DSA was performed in 82 patients with obscure gastrointestinal bleeding admitted in The Fourth Hospital of Harbin Medical University from Sept. 2008 to Oct. 2010, and the suspected lesions were treated by interventional therapy, such as arterial embolism and perfusion of drugs. Results： Of the 82 patients, DSA showed positive findings in 64 patients including 58 small intestinal bleeding and 6 postoperative anastomotic bleeding, the diagnosis rate was 78.0%. Twenty-two patients showed the direct sign of bleeding by contrast agent extravasation, and 42 patients showed indirect sign. The cause of bleeding was small intestinal tumor in 26 patients （40.6%）, and diverticulum in 18 （28.1%）. Seventeen patients were given interventional therapy, 16 arterial embolism and 1 perfusion of drugs with satisfactory responses. Conclusions： The position and cause of obscure gastrointestinal bleeding can be identified by DSA, and interventional therapy can be performed in some patients with high diagnostic and therapeutic values.