DSA诊断不明原因下消化道出血

DSA in diagnosis of lower digestive tract hemorrhage with unknown cause

目的探讨DSA诊断不明原因下消化道出血的价值。方法对18例临床诊断不明确的急性或慢性反复消化道出血患者行DSA,穿刺右侧股动脉后,将5FYashiro导管选择性插管至腹腔干、肠系膜上动脉、肠系膜下动脉以及髂内动脉造影,对部分疑有病变部位以3F微导管行超选择性插管造影。造影有阳性发现时,保留靶血管内导管,将患者送往外科手术;对有栓塞适应证者使用明胶海绵颗粒栓塞止血。结果血管造影阳性率为66.67%(12/18);5例可见对比剂外溢,间接征象包括肿瘤血管及染色2例,血管性病变5例。6例DSA阴性。5例经导管栓塞后即刻止血。结论 DSA对不明原因下消化道出血具有重要诊断价值。

Objective To evaluate the diagnostic value of DSA for lower digestive tract hemorrhage with unknown cause. Methods Eighteen consecutive patients of acute or chronic recurrent gastrointestinal hemorrhage with unknown cause were collected. Right femoral artery was punctured using Seldinger technique in all the 18 patients, and selective angiography was used to the celiac, superior mesenteric artery, superior mesenteric artery and internal iliac artery with 5F Yashiro catheter. Superselective catheter angiography with 3F microcatheter was performed for some of suspected lesions. For patients with positive DSA results, the catheter was kept in target vessel, and the patients were sent to surgical operation. Gelatin sponge particles were used for embolization in patients with indications. Results The positive rate of DSA was 66.67% （12/18）. Extravasation of contrast agent was found in 5 patients as direct feature of bleeding. Indirect signs of bleeding in- cluded tumorous vascularity and blush （n = 2） and vascular lesions （n = 5）. DSA showed negative signs in 6 patients. Bleeding stopped immediately in 5 patients after embolization. Conclusion DSA has important value in diagnosis of lower digestive tract hemorrhage with unknown cause.