内镜联合数字减影血管造影在急性消化道大出血诊治中的应用  

Endoscope Combined with Digital Subtraction Angiography in Acute Massive Gastrointestinal Hemorrhage

作　　者：欧阳博文[1] 陈延[1] 杨志刚[2] 钟媛[3] 梁自平[1] 

机构地区：[1]广东省中医院芳村医院消化内科,广东省广州市510370 [2]广东省中医院芳村医院导管室 [3]广东省中医院芳村医院内镜中心

出　　处：《中国全科医学》2013年第20期2410-2412,共3页Chinese General Practice

摘　　要：目的探讨内镜联合数字减影血管造影(DSA)在急性消化道大出血诊治中的应用价值。方法选取2008年7月—2012年7月我院收治的经内镜联合DSA救治的31例急性消化道大出血患者,对其病因诊断、止血效果、随访情况进行回顾性分析。结果 (1)31例患者中,经单纯内镜确诊20例,经DSA检查确诊29例,DSA病因诊断率为93.5%(29/31)。29例DSA确诊患者中,25例进行栓塞治疗,止血成功21例(84.0%),失败4例(1例在DSA定位后转手术治疗抢救成功,3例无法手术治疗而死亡);不适宜栓塞治疗4例,在DSA定位后转手术治疗止血成功。保守治疗成功2例,总救治成功率为90.3%(28/31)。(2)31例患者中,DSA显示造影剂血管外溢进入肠腔22例(71.0%);血管突然中断、杵状改变、血管紊乱增粗、"抱球征"等间接征象7例,在造影同时结合内镜检查结果对相应血管进行栓塞。(3)28例生存患者随访3～6个月仍存活,无再发出血。结论内镜联合DSA在诊治急性消化道大出血中能优势互补,救治成功率高,且并发症少,体现"及时、安全、有效"的急救理念,能为进一步手术治疗争取时间并做好定位。Objective To explore the value of endoscope combined with digital subtraction angiography（DSA） in acute massive gastrointestinal hemorrhage（GIH）.Methods A retrospective analysis was carried out on the etiology diagnosis,hemostasis effect,follow-up in 31 patients with acute massive GIH admitted to this hospital from July 2008 to July 2012.Results（1） Twenty patients were diagnosed with simple endoscope,29 with DSA,the rate of etiology diagnosis reaching up to 93.5%（29 /31）.In 29 patients diagnosed with DSA,25 had embolization treatment,21 had successful hemostasis（84.0%）,4 failed;4 had unfit embolism treatment and used hemostasis instead after DSA positioning.Bleeding stopped in 2 cases after internal medicine treatment,the total successful rate was 90.3%（28 /31）.（2） DSA showed extravasation into intestine in 22（71.0%） patients,sudden interruption of blood vessels,clubbing changes,vascular disorders and thickening,＂ ball-holding syndrome＂ in 7 who had embolism after taking visualization combined with endoscopic results.（3） Twenty eight patients were still alive after 3～6-month follow-up without recurrence of hemorrhage.Conclusion Endoscope combined with DSA,which can make time for further surgical treatment and do good positioning,is of high success rate in diagnosis and treatment of acute massive GIH with fewer complications.

关 键 词：胃肠出血 内镜检查 血管造影术 数字减影 诊断 治疗 

分 类 号：R573.2[医药卫生—消化系统] R574.64[医药卫生—内科学]