胃肠道动脉性大出血的急诊介入治疗

Emergent interventional therapy for massive gastrointestinal arterial hemorrhage

目的探讨急性胃肠道动脉性大出血的急诊血管造影检查及栓塞治疗的临床价值。方法 对25例急性胃肠道动脉性大出血患者行急诊腹腔动脉、肠系膜上动脉、肠系膜下动脉造影,并对可疑部位行超选择性血管造影,明确出血部位后,用明胶海绵条或颗粒、弹簧圈及聚乙烯醇(PVA)颗粒对出血动脉行栓塞治疗。术后密切观察患者生命体征变化,并定期追踪随访。结果 25例患者中,22例出血部位明确并栓塞止血成功,3例未找到出血动脉,技术成功率达88.00%(22/25)。术后随访3～20个月,中位时间6.5个月,未见严重并发症发生及再次出血。结论 急诊介入治疗是急性胃肠道动脉性大出血安全、有效的治疗手段。

Objective To observe the clinical value of emergent interventional therapy for massive gastrointestinal arterial hemorrhage. Methods Twenty-five patients with massive arterial gastrointestinal hemorrhage received selective arterial an giography of celiac trunk, superior mesenteric artery and inferior mesenteric artery. Super-selective arterial angiography was performed when necessary. Gelatin sponge particles, coils and polyvinyl alcohol （PVA） particles were used to embolize the bleeding arteries after they were confirmed. The vital signs of all the patients were observed closely after the treatment. And follow-up observation and examination were conducted regularly. Results Among 25 patients, hemorrhage parts were confirmed and successfully embolized in 22, while the hemorrhage parts were not detected in 3 patients. The total success rate was 88. 00%（22/25）. The patients were followed up for 3 to 20 months （mean 6.5 months）, no severe complication nor recurrent bleedings occurred. Conclusion Emergent interventional therapy is safe and effective for acute massive arteri- al hemorrhage of gastrointestinal tract.