消化道出血的选择性动脉造影诊断与介入治疗

Selective Angiography and Interventional Management for Gastrointestinal Hemorrhage

目的 研究消化道出血的选择性动脉造影诊断的价值及介入治疗的方法和意义。资料与方法 经选择性动脉DSA后明确消化道出血部位或原因共 57例。对非肿瘤性出血采用相应供血动脉栓塞或血管加压素局部灌注 ;肠道肿瘤及介入治疗止血不彻底者行外科切除。结果 非肿瘤性出血 41例 ,肿瘤出血 1 6例。其中 44例经动脉栓塞或灌注血管加压素治疗 ,2 5例得到完全止血 ,1 4例止血不彻底 ,5例复发。共有 32例经外科切除后得到病理诊断 ,分别为贲门溃疡 1例 ,十二指肠溃疡 7例 ,小肠憩室炎 7例 ,小肠平滑肌瘤 8例和平滑肌肉瘤 7例 ,恶性淋巴瘤 1例 ,脾动脉真性动脉瘤 1例。结论 选择性动脉造影对不明原因消化道出血的定位和定性诊断有重要的价值 ;对多数非肿瘤性出血应用选择性动脉栓塞可以得到完全止血 。

Objective To evaluate selective angiography in diagnosing gastrointestinal hemorrhage, and to discuss the interventional management.Materials and Methods The site and cause of gastrointestinal hemorrhage was verified by selective DSA in 57 patients. The bleeding not induced by neoplasm was treated with target artery embolization or vasopressin infusion. If the bleeding was caused by neoplasm or could not be completely controlled with interventional management, surgical resection was carried out.Results Non neoplastic bleeding was seen in 41 cases, while neoplasm induced bleeding in 16 cases. Arterial embolization or vasopressin infusion was carried out in 44 cases, of which the bleeding was completely stopped in 25, partially controlled in 14 and reoccurred in 5. Surgical resection was made in 32 cases, and the pathological diagnosis included cardiac ulcer (n=1), duodenal ulcer (n=7), small bowel diverticulitis (n=7), intestinal leiomyoma (n=8), intestinal leiomyosarcoma (n=7), colonic malignant lymphoma (n=1) and true aneurysm of splenic artery (n=1).Conclusion Selective angiography is of great value in determining the location and nature of the gastrointestinal hemorrhage of unknown reasons. Most non neoplastic hemorrhage can be completely controlled with transcatheter embolization. The key points to prevent complications are adopting super selective catheterization and using large embolic particles as far as possible.