动脉造影栓塞对急性消化道出血的诊疗价值

Evaluation of percutaneous angiography and arterial embolization in diagnosing acute hemorrhage of digestive tract

目的分析消化道出血的动脉造影表现,探讨经动脉栓塞治疗消化道出血的价值以及影响因素。方法回顾性分析52例消化道出血患者的资料。分析消化道出血的病因,相应的动脉造影表现;分析对于不同类型血管栓塞剂的选择及其治疗的技术成功率、临床成功率、复发率及并发症发生率。结果52例患者中DSA造影阳性者占63.5%(33/52),18例表现为直接阳性征象,11例表现为间接阳性征象,4例表现兼有直接和间接阳性征象。33例造影阳性患者中24例行经动脉栓塞治疗,技术成功率为91.7%(22/24),临床成功率为62.5%(15/24),复发率为37.5%(9/24)。结论经动脉造影及栓塞能快速发现出血部位并有效控制出血,是急性消化道动脉性出血的有效诊疗手段;出血的病因、造影表现和出血动脉多样,其诊断率、栓塞的技术成功率和临床成功率的影响因素较多。

Objective To analyze the angiographic manifestations of digestive tract hemorrhage, to evaluate percutaneous transcatheter arterial embolization in treating digestive tract hemorrhage, and to discuss the factors that may influence therapeutic results. Methods A total of 52 patients with digestive tract bleeding were enrolled in this study. The clinical data, focusing on the causes of bleeding and corresponding angiographic manifestations, were retrospective analyzed. The selection of embolic agents for different arterial branches, the technical success rate, the clinical cure rate, the recurrence rate as well as the complications were analyzed. Results Among the 52 cases, positive DSA findings were observed in 33（63.5%）, including direct positive signs only（n = 18）, indirect positive signs only（n = 11） and both direct and indirect positive signs（n = 4）. Transcatheter arterial embolization was carried out in 24 cases, and the technical success rate was 91.7%（22/24）. The clinical cure rate and the recurrence rate were 62.5%（15/24） and 37.5%（9/24）respectively. Conclusion Transarterial angiography together with embolization can quickly determine the bleeding site and at the same time can effectively stop the bleeding. Therefore, percutaneous angiography and arterial embolization is an effective treatment for acute digestive tract hemorrhage. There are a variety of causes, angiographic manifestations and responsible arteries in acute digestive tract hemorrhage, and many factors can influence the technical success rate and the clinical cure rate.