动脉性消化道出血的血管造影诊断和介入治疗

Angiographic Diagnosis and Transcatheter Therapy of Gastrointestinal Arterial Hemorrhage

目的 评价动脉性消化道出血血管造影诊断和介入治疗的临床应用价值。方法 动脉性消化道出血 36例 ,男 2 3例 ,女 13例。 9例行急诊血管造影 ;2 7例经保守治疗后择期行血管造影。经选择性插管造影 ,筛选出出血动脉后 ,采用同轴导管法超选择性插管 ,行血管加压素灌注治疗或栓塞治疗。结果 血管造影诊断出血的阳性率是 41.6 7%。急诊造影组阳性率 77.8% (7/ 9) ;择期造影组阳性率 2 9.6 % (8/ 2 7) ;两者有显著差异 (P <0 .0 0 5 )。血管加压素灌注治疗 3例中 2例有效 ,且 1例复发 ;栓塞治疗组有效率 10 0 % ,无复发。有 1例死于多器官功能衰竭。无其他严重并发症。结论 血管造影和介入治疗在动脉性消化道出血中有着重要的诊断和治疗价值 ,栓塞治疗安全、有效。

Purpose To evaluate the clinical value of angiographic diagnosis and effectiveness of transcatheter therapy in gastrointestinal arterial hemorrhage. Methods Angiography were studied in 36 patients with gastrointestinal hemorrhage, as 9 of them performed in acute emergency, the others practiced semi electively. Bleeding site of suspected gastric or mesenteric artery was identified by selective arteriography. Intraarterial vasopressin infusion or embolotheraphy was used after superselective catheterization of the bleeding branch artery. Results 41.67% of these patients were identfied by angiography. Diagnostic rate of acute emergency angiographies was significantly higher than that of semi elective. 2 in 3 cases treated with vasopression infusion were effective , but 1 rebled in 30days.Cases treated by embolotherapy were all successful with no recurrent. There was 1 case died of multi organ function failure, no other important syndromes happened. Conclusion Interventional radiology is valuable for diagnosing and treating gastrointestinal arterial hemorrhage. Embolotherapy is a safe and efficient method. [