超选择性血管造影并栓塞治疗空回肠出血灶

目的探讨经皮肠系膜上动脉造影并选择性栓塞术治疗空回肠急慢性出血病灶的可行性。方法对6例空回肠急慢性出血患者进行回顾性分析和总结，其中空肠壁血管畸形2例，空肠间质瘤1例，回盲部溃疡并出血3例。均经皮肠系膜上动脉造影明确诊断及出血部位，超选择微导管插入靶血管注入明胶海绵颗粒栓塞止血，再造影复查显示止血成功。除1例空肠间质瘤未能排除恶性肿瘤，10天后行择期剖腹术外，其余5例均未再行手术，随访至今情况良好。结果5例空回肠及回盲部溃疡出血患者经超选择性动脉造影并栓塞治疗，全部即时止血成功，1例空肠间质瘤明确诊断并及时手术，所有患者均痊愈出院。结论空回肠出血部位性质的确定，特别对出血量大而时间较久的患者，内科疗法效果不理想，剖腹探查有较大的盲目性，经皮肠系膜上动脉超选择性动脉造影并栓塞止血，创伤小、并发症少，可同时进行诊断、治疗，具有其独特的优越性，值得推广。

The Discussion for Using Superselective Angiography and Transarterial Embolization to Treat Jejunum and Ileum Hemorrhagic Focus

Objective To reseach the curative effect of percutem selecting superior mesenteric artery anglography and transarterial embolization. Methods There were 6 patients during Junuary 2001 to April 2004, two cases were jejunum wall's vascular malformation, one case was jejunum interstitialoma, the other three cases were Fallopian valve ulcer. By the way of using superselective angiography, we can fix and diagnose hemorrhagic focus. Firstly, we can use superselective canal insert target vascular, then inject glutin sponge granules to embolism. one case of jejunum interstitialoma cannot exclude malignancy,while bleeding the others are controlled of successfully. Results The 6 patients are all hemostasis and recovery per cutem super-selective angiography and are successfully embolizated. Conclusions With the help of gastroscope, ERCP and enteroscpoe, the diagnoses and fixing of upper gastrointerstintal tract and colonorrhagia are basicly resolved. But there are some difficulties about identifying qualitative of jejunum and ileum bleeding parts, especially to those who shock with bleeding, medical treatments have no ideal means. Abdominal incision has some blindness, while choosing the superselective angiography and transarterial embolization percutem superior mesenteric artery, there is few side-effectes. At the same time, we can diagnose, embolize the hemostasis. It has distinctive superiority and deserve utilization.