医源性上消化道大出血的选择性血管造影诊断及栓塞治疗  

Selective angiographic diagnosis and transcatheter arterial embolization of iatrogenic massive upper gastrointestinal bleeding

作　　者：段旭华[1] 郑传胜[1] 冯敢生[1] 梁惠民[1] 黄锐[1] 任建庄[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院放射科,湖北省武汉市430022

出　　处：《世界华人消化杂志》2009年第10期1048-1052,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨医源性上消化道大出血的选择性血管造影诊断及栓塞治疗的临床应用价值.方法:对37例医源性上消化道大出血行选择性血管造影,根据消化道出血至血管造影的时间分为急诊组(28例)、非急诊组(9例),对比分析.术中根据不同出血原因和出血部位,采用不同栓塞材料栓塞.结果:本组血管造影阳性33例,总阳性率89.2%(33/37).急诊组阳性率96.4%(27/28),非急诊组阳性率66.7%(6/9);急诊组选择性血管造影检出阳性率明显高于非急诊组,两组差异有统计学意义(P<0.05).造影阳性33例病例中31例栓塞后立刻止血;2例重症胰腺炎栓塞治疗1wk后再出血,再次栓塞后止血;1例重症胰腺炎栓塞术后立刻止血,术后13d死于多器官功能衰竭.造影阴性4例行试验性栓塞,3例成功止血,1例无效,外科手术止血.术后随访3-12mo,患者无再出血及肠坏死等严重并发症.结论:急诊选择性血管造影能提高医源性上消化道大出血的造影阳性率,对出血部位的诊断具有重要意义.经导管栓塞治疗是安全有效的止血措施.AIM： To study the clinical value of angiography and transcatheter arterial embolization （TAE） for the iatrogenic upper gastrointestinal hemorrhage. METHODS： Thirty seven cases with iatrogenic hemorrhage in the upper digestive tract received emergency selective angiography. According to the interval from bleeding onset to angiographic time, patients were divided into two groups, that is, the emergency group （n = 28 cases） and non-emergency group （n = 9 cases）. According to find out positions and causes of bleeding during angiography, all patients underwent arterial embolization with different embolic agents. RESULTS： DSA revealed positive result in 33 cases of 37cases with a total positive rate of 89.2% （33/37）. The positive rate for the emergency group was 96.4% （27/28） and 66.7%（6/9） for non-emergency group. Positive rate of angiography was significantly higher in emergency group than in non-emergency group （P 〈 0.05）. Arterial embolization was successfully carried out in 31 positive cases; 2 severe pancreatitis cases rebled I week after embolization and was treated successfully with re-embolization. One severe pancreatitis case had no bleeding, but died of multi-organ function failure 13 days later. Of four cases with negative angiography who undertook trial embolizing therapy, bleeding ceased in 3 cases; 1 case who failed bleeding was given surgery to stop bleeding. During the 3-12 month-follow-up, there were no relapse or complications. CONCLUSION： Emergency selective angiog- raphy improves positive rate and plays an important role in detecting the sites of iatrogenic upper gastrointestinal massive bleeding. Selective arterial embolization is a safe and effective hemostatic measure.

关 键 词：医源性 上消化道大出血 血管造影 动脉栓塞 

分 类 号：R573.2[医药卫生—消化系统] R697.14[医药卫生—内科学]