急性下消化系动脉出血的介入诊疗价值和影响因素  

Angiography and transcatheter embolizaion for acute lower gastrointestinal hemorrhage:clinical value and influencing factors of diagnosis and treatment

作　　者：王永利[1] 程英升[2] 张家兴[1] 汝复明[1] 曹传武[1] 徐霁充[1] 

机构地区：[1]同济大学附属上海第十人民医院介入科,上海市200072 [2]上海交通大学附属第六人民医院介入影像科,上海市200233

出　　处：《世界华人消化杂志》2008年第34期3919-3924,共6页World Chinese Journal of Digestology

摘　　要：目的:探讨血管造影、经导管栓塞术在急性下消化系动脉出血中的诊疗价值及影响出血诊断和栓塞疗效的因素.方法:回顾性分析血管造影和经导管栓塞术治疗39例急性下消化系动脉大出血病例.记录术前、后输血量、血压变化和血红蛋白改变.随访3-6mo,评价技术成功、临床成功、迟发性出血和并发症.结果:栓塞术前,39例患者中26例输注红细胞悬液,术后仅4例患者(术前Hb均<40g/L)输注红细胞悬液.肠系膜上、下动脉(2级血管)开口造影,出血阳性诊断率31%;空肠、回肠、回结肠、结肠动脉和边缘动脉等(3级)分支血管开口造影,出血阳性诊断率69%(27/39).总血管造影出血阳性率100%.即刻有效栓塞率达92%,栓塞的技术成功率和临床成功率分别为100%和89.7%.手术操作和栓塞所致动脉痉挛,一过性腹部隐痛4例,2例对症处理后缓解,2例自行缓解.3d后的肠镜检查,4例患者显示出栓塞区肠黏膜红斑,周围水肿、苍白,但无1例患者出现严重并发症.结论:血管造影、经导管栓塞术是急性动脉性下消化系出血定位诊断和安全、有效的急诊治疗手段.血管造影出血的阳性诊断率和栓塞治疗的疗效受多种因素影响.AIM： To evaluate the clinical value of angiography and transcatheter embotherapy in patients with acute massive lower gastrointestinal （GI） hemorrhage, and to analyze the influencing factors. METHODS： We retrospectively analyzed data of 39 cases with acute massive arterial hemorrhage of lower gastrointestinal tract, including such data as transfusion amount, blood pressure and hemoglobin （Hb） before and after embolization. Baseline, procedural, and outcome parameters were recorded in accordance with current Society of Interventional Radiology guidelines. Fol- low-up time was three to six months. Outcomes included technical success （Immediate disappearance of bleeding signs or obstruction of leaking-blood artery after embotherapy）, clinical success （without rebleeding within 30 days）, delayed rebleeding （more than 30 days）, and major or minor complication rates. RESULTS： Twenty-six patients of the 39 with acute massive lower GI hemorrhage received blood transfusion before embolization, and only 4 patents with HB below 40 g/L before embolization, received the transfusion post-embolization. The positive diagnostic rates of lower GI hemorrhage of angiograms were 31% with catheter-tips located at 2na-grade-blood vessels （superior mesenteric arteries, inferior mesenteric arteries）, and 69% at 3rd-grade-blood vessels （jejunal artery, iliac artery, iliac-cecal artery, cecal artery, and marginal artery）, respectively. The total positive diagnostic rate of angiography about lower GI bleeding reached 100%. Embolization was performed with injection of gelatin sponge particles or thin strips via catheter following angiogram with angiographical catheter （5French size） or with microcatheter （3French size）. Immediate cessation bleeding post-embolization was 92%. The technical success rates and clinical success rates reached 100% and 89.7%, respectively. Transient epigastric pains occurred to 4 patients because of superior mesenteric artery spasm, 2 cases were managed with medicati

关 键 词：下消化系动脉出血 血管造影 经导管栓塞术 

分 类 号：R574.9[医药卫生—消化系统]