DSA结合3D-DSA和XperCT诊断下消化道大出血

DSA combined with 3D-DSA and Xper-CT for the diagnosis of lower digestive tract massive hemorrhage

目的探讨传统DSA造影结合3D-DSA、XperC T功能诊断下消化道大出血的意义。方法收集15例急性消化道大出血患者,病因不明确。所有患者均作股动脉或肱动脉穿刺,5 F Yashiro导管或RLG导管选择至腹腔干、肠系膜上动脉、肠系膜下动脉及髂内动脉作造影,对疑有病变部位用3 F微导管作超选择造影,同时作3D-DSA和XperC T扫描。诊断后即行外科切除术。结果 15例患者均成功完成DSA结合3D-DSA、XperC T检查。8例诊断为血管畸形(小肠6例,结肠2例),6例诊断为肿瘤性病变(小肠肿瘤5例,结肠肿瘤1例),1例定位于小肠出血(原因不明)。外科手术切除病变后病理学诊断显示血管畸形8例(53.3%),小肠间质瘤4例(26.7%),小肠腺癌1例(6.7%),结肠癌1例(6.7%),小肠憩室1例(6.7%)。结论传统DSA造影结合3D-DSA、XperC T用于定性、定位诊断下消化道大出血有重要临床价值。

Objective To evaluate the eonventional DSA combined with 3D-DSA and Xper-CT in diagnosing lower digestive tract massive hemorrhage of unknown reason. Methods A total of 15 continuous patients with acute digestive tract massive hemorrhage of unknown reason, who were encountered in authors＇ hospital, were collected. Puncture of right femoral artery or brachial artery with Seldinger teehnique was performed in all patients ; a 5 F Yashiro or RLG catheter was selectively and respectively inserted into the celiac trunk, superior mesenterie artery, inferior mesenterie artery and internal iliac artery to carry out angiography; for the site with suspected lesions the superselective angiography with a 3 F mieroeatheter was adopted and meanwhile 3D-DSA and Xper-CT scans were conducted. Surgical resection was ean＇ied out immediately after the diagnosis was confirmed. Results DSA combined with 3D-DSA and Xper-CT was successfully accomplished in all 15 patients. Of the 15 patients, vascular abnormalities were confirmed in 8 （6 in small intestine and 2 in colon） , tumor lesion was diagnosed in 6 （5 in small intestine and one in colon） and the bleeding of unknown reason was located in small intestine in one. Pathological diagnoses of the surgical specimens included vascular malformation （ n = 8, 53.3% ） , small intestinal stromal tumor （ n = 4, 26.7% ） , small intestinal carcinoma （ n = 1, 6.7%）, colon cancer （n= 1, 6.7%） and small intestinal divertieulmn （n = 1, 6.7%）. Conclusion In making qualitative and locating diagnosis of lower digestive tract massive hemorrhage of unknown reason, conventional DSA combined 3D-DSA and Xper-CT is of great clinical value.