下消化道出血栓塞治疗的实验研究

The Experinental Study for Transcatheter Embolic Treatment of Lower Gastrointestinal Hemorrhage

目的 :研究下消化道出血的可栓塞性及可栓血管范围 ,为临床下消化道出血的栓塞治疗提供参考依据。方法 :杂种犬 6只 ,5只结扎小肠和结肠直动脉 1～ 5支及上一级分支和上二级分支 ,术后 30min ,2 4h及 1周观察肠管缺血情况及有无坏死。其中一只 1月后观察肠管有无纤维狭窄。另一只复制 6个出血模型 ,分别作直动脉及其上一级分支的栓塞 ,观察止血效果。结果 :栓塞小肠及结肠直动脉 1～ 5支和直动脉上一级分支后 ,实验段肠管呈一过性缺血 ,无肠管坏死及纤维狭窄。造影见实验段肠管出现乏血管区 ,肠壁隐约显影。直动脉上二级分支栓塞部分发生肠坏死。出血模型栓塞显示单支直动脉栓塞达不到止血效果 ,需作多支栓塞 ;直动脉上一级分支的栓塞仍可见少量造影剂外溢。结论 :在不伤及肠壁微血管的情况下 ,下消化道直动脉及其上一级分支的栓塞是安全的。直动脉的栓塞止血效果肯定 ,其上一级分支的栓塞可明显减少出血量 ,而上二级分支的栓塞则可以引起肠坏死。

Objective:To study the safety and validity of transcatheter embolic treatment for lower gastrointestinal hemorrhage by animal experiment. Methods:There were six mengrol dogs.One to five straight arteries of intestine were ligated for five dogs.Whether there was ischemia and necrosis of lower gastrointestine was observed within 30 minutes,24 hours and one week after operation and angiography was made.Then the first and second branch pre straight artery was ligated to continue observed.Six hemorrhagic models of intestine were made for one dog.The straight artery and the first branch artery embolism were made separtely to observe the effective haemostasis.Results:There was transitoty ischemia on experimental segment of intestine after one to five straight arteries being ligated and no necrosis and fibrostenosis was found,Angiography showed a defective vascular zone on experimental segment intestine.Embolism of hemorrhagic models demostrate that to get a effective heamostasis multiple straight arteries should be embolized and there still was little extravasation angiographically when the first branch pre straight artery was ligated.Conclusion:It is safe to embolize the straight artery and the first branch pre straight artery if the microvasculature in intestinal wall hadn't been damaged and the straight artery embolization is the best way to stop intestinal bemorrhage and it may result in intestinal infarction if the second branch pre straight artery were embolized.