CTA在消化道出血诊疗中的指导价值研究

Study on the Guiding Value of CTA in the Diagnosis and Treatment of Gastrointestinal Bleeding

目的探讨CTA在消化道出血诊疗中的指导价值。方法回顾性分析我院收治的60例经临床确诊的消化道出血患者资料,包括术前、术后CTA检查及DSA资料,同时记录介入栓塞术总时间、曝光时间、造影次数及总射线剂量。入组病例中30例为实验组(术前行CTA),余30例为对照组(术前未行CTA),两组术后1天均行CTA,将以上数据进行统计学分析。结果实验组与对照组的入组患者年龄中位数、男女比例及体重中位数差异无统计学意义。实验组介入栓塞术总时间(65±12)min、曝光时间(218±22)s、造影次数(4±1)次、总射线剂量(468±35)m Gy分别较对照组(81±15)min、(309±36)s、(6±2)次、(587±48)m Gy减少,且均有统计学差异(P<0.05);60例患者介入栓塞术后CTA检查,发现3例仍有消化道出血,再次行介入栓塞术后复查CTA提示出血停止。所有患者术后随访过程中未见明确出血征象。结论急性消化道出血的患者在介入栓塞治疗前行CTA检查可以评估出血位置、出血流量、血管走行,对手术有重要的指导作用,有效缩短介入栓塞术总时间、曝光时间、减少造影次数及射线剂量;介入栓塞后复查CTA能够评估术后疗效,及时发现出血病灶,值得临床推广。

Objective To explore the value of CTA in the diagnosis and treatment of gastrointestinal bleeding. Methods The clinical data of 60 patients with gastrointestinal hemorrhage were analyzed retrospectively, including preoperative and postoperative CTA examination and DSA data. The total time of interventional embolization, the time of exposure, the number of radiographs and the total radiation dose were recorded at the same time. There were 30 patients in the experimental group, who were examined by CTA before operation, and there were 30 patients in the control group who did not undergo eTA examination before the operation. CTA examination was performed 1 days after operation in the two groups, and the data above were analyzed statistically. Results The median age, the proportion of men and women and the median weight of the patients in the experimental group and the control group were basically the same, the difference was not statistically significant. The total time （65± 12） min, the exposure time （218± 22）s, the number of angiography （4 ± 1） and the total radiation dose （468 ±35）mGy in the experimental group were significantly bighter than those in the control group（81 ±15）min, （309± 36）s,（6 ± 2）, （587 ± 4g）mGy （P 〈0.05）. All cases underwent CTA after embolization, and gastrointestinal bleeding was found in 3 cases, followed by interventional embolization again, arid CTA indicated bleeding stopped. No definite bleeding signs were found in all patients during the follow-up. Conclusion CTA examination before interventioual embolization can evaluate the location of bleeding, the flow of bleeding and the shape of blood vessel, which have important guiding effect on the operation. It can shorten the total time of interventional embolization, the time of exposure, the number of radiography and the dose of radiation, The CTA examination after the interventional embolization can evaluate the curative effect and find the bleeding lesion in time, so it is worthy of clinical promotion.