消化道出血血管造影及介入治疗价值

Value of emergercy angiography and interventional therapy of digestive tract hemorrhage

目的 探讨消化道出血的急诊血管造影和介入治疗价值。方法 对 12 3例消化道出血病例进行急诊血管造影 ,初次造影未发现出血灶的病例 ,灌注扩血管药物后复查。根据造影检查前临床是否有出血表现 ,将其分为甲、乙两组作对比分析。术中按不同出血原因和部位再采用动脉栓塞或 (和 )缩血管药物灌注治疗。结果 出血活动期病例出血检出阳性率为 90 .8% ,出血静止期病例出血检出阳性率为 47.2 % ;动脉栓塞治疗即时止血率为 10 0 % ;无严重并发症。缩血管药物灌注治疗即时止血率为82 .7%。结论 消化道出血在出血活动期行急诊血管造影检出阳性率明显高于出血静止期 ,两组差异有显著性 (P <0 .0 1) ;动脉栓塞或缩血管药物灌注治疗是安全。

Objective To study the value of emergency angiography and interventional therapy in digestive tract hemorrhage. Methods 123 cases was performed with repeated angiography after perfusing vasodilator substance in those patients without bleeding signs in the first angiography. According to with or without bleeding during angiography, these cases were divided into group A (the patients is bleeding during angiography) and group B (the patients' stool bleeding examined were negative before angiography) for analysis. The patients with bleeding demonstrated angiographically had accepted the arterial embolization and/or infusion of vasoconstrictor substance later on. Results 90.8% patients of group A was found bleeding and 47.22% patients of group B was found bleeding on angiography. Bleeding was stopped immediately in all those patients with arterial embolization and 82.7% of those patients with vasoconstrictor substance infusion. Conclusions The detective rate of bleeding in active stage is greater than that of in resting stage on emergency angiography of patients with digestive tract hemorrhage ( P <0.01). Arterial embolization or vasoconstrictor substance perfusion are safe and effective hemostatic ways. Though the recurrence rate is high after vasconstrictor substance perfusion but still race against time for surgical operation.