顽固性上消化道出血多学科联合诊疗模式的探讨

The Exploration of Joint Multi-disciplinary Treatment Mode for Intractable Hemorrhage of Upper Gastrointestinal

目的:回顾性分析上消化道溃疡顽固性出血患者诊疗过程,探讨多学科的联合救治模式。方法:收集上消化道顽固性出血患者16例,对其药物治疗的同时行急诊胃镜检查,诊断为上消化道溃疡、确定溃疡部位,并排除食管胃底静脉曲张破裂出血。DSA血管造影检查均为阴性,依据溃疡病灶的部位,超选择性插管明胶海绵颗粒栓塞相应部位的供血动脉。结果:所有患者15例治疗成功,1例病情进展。联合治疗模式总有效率93.75%,其中介入治疗有效率87.5%,外科治疗有效率50.0%。结论:内科治疗为基础,联合胃镜、介入治疗及外科手术的协作模式,可明显提高顽固性消化道出血的救治成功率。

Objective： To retrospective analysis the patients＇ treatment of intractable hemorrhage of in upper gastrointestinal ulcer, to explore combined treatment of multi discipline.Method： 16 patients with intractable hemorrhage of upper gastrointestinal ulcer in our hospital were selected, adopted medication and emergency gastroscopy, which diagnosed upper gastrointestinal ulcer.Confirmed the ulcer location, and excluded the varicosis bleeding of esophagus and gastric.DSA angiography all showed negative.According to the position of ulcer lesion, using super-selective catheterization gelatin sponge to embolize the artery of relevant parts of the body.Result： In all 16 cases, the treatment was successful in 15 cases, 1 case progressed.The total effective rate of combined treatment mode was 93.75%, thereinto, the interventional treatment effective rate was 87.5%, and the effective rate of surgical treatment was 50.0%.Conclusion： Medical cure as the basis, the cooperation mode of combined with gastroscopy, interventional treatment and surgical operation, which can significantly improve the treatment success rate of intractable hemorrhage of digestive tract.