不明原因消化道大出血的急诊介入治疗

The massive hemorrhage of unknown cause in digestive tract: emergency interventional therapy

目的 :探讨不明原因消化道大出血介入治疗的临床应用价值。方法 :运用Seldinger技术 ,对 2 6例不明原因急性消化大出血患者 ,进行急诊选择性造影 ,灌注和超选择栓塞术 ;对 7例常规造影无病变发现的患者运用药物诱导后进行造影。结果 :常规造影 19例有异常表现 ,7例药物诱导后 ,3例发现异常 ,总的阳性率为 85 % ;表现为造影剂外溢征 ( 12例 ) ,新生肿瘤血管和肿瘤染色征 ( 15例 ) ,动静脉畸形 ( 2例 ) ;4例导管治疗后复发出血 ,占 15 .4%。结论 :急诊介入放射对不明原因消化道大出血的治疗是一种安全而有效的方法 ,能达到诊断和治疗的双重目的 ;对常规造影无病变发现的患者 ,有必要进行药物诱导后造影。

Objective:To investigate the efficacy of emergency interventional therapy on the digestive tract hemorrhage with unknown reason.Methods:26 cases of the digestive tract hemorrhage with unknown cause were performed selective angiography,infusion of drug and superselective embolization by Seldinger's technique.7 cases were demonstrated normal on routine angiograms and then followed by drug inducing angiography.Results:19 cases were shown abnormal on routine angiograms,and 3 of 7 cases following drug inducing angiography were also documented abnormal.The total detectability was 85%.Angiograms demonstrated contrast medium leakage (n=12),tumor vessels and tumor staining (n=15) and AVM (n=2). 4 cases following interventional therapy recurred bleeding.Conclusions: Emergency interventional therapy is a safe and effective method for gastrointenstinal bleeding with unknown reason.It is important for using drug inducing angiography while routine angiograms appear negative.