急性消化道出血DSA诊断与介入治疗疗效探索

DSA and interventional therapy in acute gastrointestinal hemorrhage

目的探讨急性消化道出血的DSA诊断价值与治疗疗效。方法搜集不明原因的消化道出血25例,均行DSA检查,对于阳性患者进行明胶海绵栓塞+垂体后叶素灌注治疗。结果DSA检查发现阳性患者18例,阳性率为72%,直接发现出血点10例,行明胶海绵栓塞+垂体后叶素灌注治疗,怀疑出血点8例,行垂体后叶素灌注治疗。其中胃十二指肠区域出血患者6例,其余小肠区域出血9例,结直肠出血3例;溃疡疾病导致出血5例,肿瘤性病变2例,憩室1例,血管性病变4例,吻合口出血6例。术后再出血3例,内科继续保守止血治疗4例,外科手术治疗6例。结论介入治疗方法作为一种行之有效的微创治疗方法值得推广。

Objective To explore the diagnostic value and effects of digital subtraction angiography （DSA） for acute gastrointestinal hemorrhage. Methods Twenty-five patients of gastrointestinal hemorrhage of unknown reasons were examined by DSA , and the positive ones were treated by the gelfoam embolization combined with pituitrin infusion. Results Eighteen of the twenty-five patients showed positive signs, taking up the rate of 72%. Ten patients, directly found the petechiae, were treated by gelfoam embolization combined with pituitrin infusion embolization. Eight cases of suspected petechiae were given pituitrin infusion treatment. Six patients were hemorrhage of gastroduodenal, 9 of the rest of small intestine, 3 of colon and rectum. 5 cases were caused by the hemorrhage of ulcer disease, 2 by neoplastic lesions, 1 by diverticulum, 4 by vascular lesions, and 6 by anastomotic hemorrhage. Postoperative hemorrhage was found in 3 patients. Four cases were still given conservative medical treatment, and 6 of surgery. Conclusion DSA, an effective and minimally invasive interventional treatment, is worth generalizing on clinic.