数字减影血管造影与介入治疗在胃肠道动脉性出血中的应用价值

目的 探讨数字减影血管造影(DSA)诊断与介入治疗在胃肠道动脉性出血中的应用价值.方法 回顾性总结78例消化道动脉性出血患者的DSA表现和动脉栓塞、药物灌注的治疗经验.结果 本组患者十二指肠溃疡15例,胃溃疡5例,胃癌2例,Dieulafoy病1例,血管畸形和发育不良9例,胃肠术后吻合口出血8例,肝胆疾患术后肝动脉破裂出血10例,Crohn病5例、肠道憩室出血6例、小肠炎或溃疡6例,小肠息肉3例,小肠中度恶性间质瘤1例,小肠高分化平滑肌肉瘤2例,直结肠癌5例.74%(58/78)的患者DSA造影阳性,造影剂外溢直接征象者33%(26/78),术后吻合口出血直接征象者83%(15/18).介入治疗的病例中动脉药物灌注15例,技术成功率60%(9/15),临床成功率40%(6/15);栓塞36例,技术成功率86%(31/36),临床成功率72%(26/36);介人治疗后再出血率16%(8/51),其中1例栓塞后再呕血经胃镜治疗无效死亡.DSA造影和介入治疗后手术者27例,造影与术后病理诊断的符合率为78%(21/27).随访时间2个月至3年,未发生胃肠道缺血坏死等并发症.结论 DSA对消化道动脉性出血的定位、定性有着重要价值,选择性动脉栓塞及药物灌注止血安全有效,有助于择期手术和并发症处理.

Application of digital subtraction angiography and interventional treatment in gastrointestinal arterial hemorrhage

Objective To investigate the clinical value of digital subtraction angiography (DSA) and interventional treatment in gastrointestinal arterial hemorrhage. Methods DSA data and experiences of interventional treatment of 78 cases with gastrointestinal arterial hemorrhage were retrospectively analyzed. Results The positive rate of DSA diagnosis was 74%(58/78). Contrast media overflow direct sign was found in 33% (26/78) patients. Contrast media overflow direct sign of postoperative anastomotic stoma was found in 83% (15/18) patients. Hemorrhage causes of 15 cases were duodenal ulcer, 5 stomach ulcer, 2 gastric cancer, 1 Dieulafoy disease, 9 vascular malformation and dysplasia, 8 in anastomotic stoma bleeding after gastrointestinal operation, 10 hepatic artery blow out and bleeding after operation of liver disease, 5 Crohn disease, 6 intestinal tract diverticulum hemorrhage, 6 enteritis or ulcer and 3 polyp of small intestine, 1 midrange malignant small intestinal interstitial tumor, 2 well differentiated small intestine leiomyosarcoma, 5 colon and rectal cancer. Fifteen cases received arterial drug infusion and 36 received arterial embolization. Twenty-seven cases underwent operation after DSA and interventional treatment, whose coincidence with pathology was 78%(21/27). Technical success rate of arterial embolization was 86%(31/36) and clinical success rate was 72% (26/36). Technical success rate of arterial drug perfusion was 60%(9/15) and clinical success rate was 40%(6/15). Rebleeding rate was 16%(8/51) after intervention treatment. During follow-up for 2-36 months, 1 reblecding patient received gastroscope treatment after embolization, but failed and died later. There were no severe complications, such as ischemic necrosis, in all the cases. Conclusion DSA is very important for the location and qualitation of gastrointestinal arterial hemorrhage. Transartetial drug infusion and embolization are safe and effective, and available to selective operation and complication handling.