DSA对下消化道出血的诊断价值(附32例分析)

目的：探讨DSA对下消化道出血的诊断价值。资料与方法：对32例不明原因性消化道出血患者进行DSA检查，19例经手术病理证实。结果：DSA发现25例病变，阳性率为78．1％。其中血管性病变13例，肿瘤6例，憩室2例，非特异性炎症1例，溃疡2例，息肉1列。结论：DSA对下消化道出血，尤其对小肠和胆道出血病变的定位、定性诊断具有重要价值。     

DSA在肾动脉栓塞治疗肾损伤出血中的应用价值

目的：探讨数字减影血管造影（DSA）在肾动脉栓塞治疗肾损伤出血的应用价值。方法：对27例肾出血患者行选择性肾动脉、DSA造影，其中肾外伤出血21例，医源性损伤6例。27例中23例行超选择性栓塞治疗，4例经导管局部灌注立止血。结果：DSA影像清晰显示损伤部位位于肾段或段以下肾动脉分支，栓塞治疗快捷、彻底。手术平均用时仅40分钟。术后1-4天出血即停止。经输血，扩容后，血压和血红蛋白回升，随访无复发性血尿。结论：DSA检查为肾动脉出血栓塞治疗提供了，确切、实时的图像，为介入栓塞的操作提供了极大的帮助，客观、及时地评价了介入栓塞的效果，具有较高的应用价值。     

下消化道非肿瘤性出血的DSA诊断与介入治疗

目的探讨下消化道非肿瘤性出血的DSA诊断和介入治疗的临床价值。方法经DSA诊断的下消化道非肿瘤性出血21例,8例采用明胶海绵栓塞,13例采用血管加压素灌注。结果出血原因为肠血管发育不良14例,结肠憩室2例,原因不明5例。全部病例获得止血。未出现严重并发症。随访5～74个月,4例肠血管发育不良出血复发。结论DSA对下消化道非肿瘤性出血的诊断很有价值。介入方法对其治疗安全有效,部分病例可获得根治。     

消化道出血DSA检查及介入治疗的临床意义

目的　讨论DSA检查及介入治疗对消化道出血的临床价值。方法　对 44例患者先行腹腔动脉 ,肠系膜上、下动脉DSA检查。根据DSA表现 ,采用灌注垂体后叶素或用明胶海绵粉和弹簧栓子栓塞治疗。结果　 44例中 ,32例血管有异常表现 ,1 9例见造影剂外溢并行垂体后叶素灌注 ,7例用明胶海绵粉栓塞 ,2例胰腺癌术后小肠出血、4例胆道出血用弹簧栓子栓塞出血停止。结论　诊断不明确或保守治疗无效的消化道出血患者DSA检查及介入治疗有着重要的临床价值     

不明原因消化道出血的影像学检查

消化道出血的检查方法有消化道内镜、影像学和手术探查,其中影像学检查大多无创,对进一步消化道内镜检查、介入栓塞治疗和手术治疗均有指导意义。其中显性出血的影像学检查以CT血管造影、DSA和99mTc-RBC显像为主要检查方法,隐性出血的主要成像方法有CT小肠造影、99mTcO4-显像。当胃镜和结肠镜检查未发现异常,推测出血可能源于小肠时,需进行小肠检查。目前CT小肠造影不仅有可能检测到小肠隐匿性出血,而且还可以提供肠腔内外的病变信息,达到病因诊断。     

原因不明消化道出血的DSA诊疗价值

目的：探讨原因不明消化道出血中的DSA诊断和治疗。方法：对17例原因不明消化道出血行DSA检查，10例行栓塞治疗，5例行垂体后叶素灌注。结果：有阳性发现者15例（阳性率88％），15例均明确出血部位，其中11例明确病变性质（73％）。结论：DSA对原因不明消化道出血的定位和定性诊断有较高价值，DSA下栓塞治疗或垂体后叶素灌注对急性期止血和择期手术有帮助。     

外科术后出血的DSA诊断及介入治疗

目的 探讨DSA诊断及介入治疗在外科术后出血的应用价值.方法 回顾分析2005年8月-2008年1月经DSA诊断及介入治疗的14例外科术后出血患者的临床资料及疗效,其中胃大部切除术后4例,胰十二指肠切除术后3例,削宫产术后2例,肾结石取石术后3例,肾血管平滑肌脂肪瘤术后1例,内痔术后1例.结果 共发现17处动脉出血,其中胃十二指肠动脉出血2例,胃左动脉出血4例,膈动脉出血1例,胃短动脉出血1例,肠系膜上动脉出血2例,肾动脉出血4例,子宫动脉出血2例,阴部内动脉的肛动脉出血1例.全部病例经DSA明确诊断,其中13例进行栓塞治疗,均一次性栓塞止血成功,1例超选插管失败而再次外科手术止血,止血有效率达92.3%.所有病例均无器官坏死、功能障碍等并发症发生.结论 DSA在外科术后出血的诊断及介入治疗上具有定位准确、创伤小、操作时间短、安全、疗效可靠等优点,具有重要的临床应用价值.     

原发性肝癌DSA影像表现的分析

本文对１００例中晚期原发性肝癌ＤＳＡ影像表现进行了动态观察分析，认为：中晚期肝癌使ＤＳＡ显影的时相发生明显改变，肝动脉、门静脉血供比例失调，门静脉血回流受阻。观察分析中晚期肝癌的ＤＳＡ表现具有重要的临床价值。     

旋转肾动脉DSA的临床应用

目的　探讨旋转肾动脉DSA临床应用的可行性。方法　回顾性分析 48例肾肿瘤患者腹主动脉DSA检查中肾动脉的解剖情况。测量 5 0例腹部CT增强扫描肾动脉开口的位置、方向。观察 16例旋转肾动脉DSA的效果。结果　 48例常规腹主动脉DSA中 ,右肾动脉开口、主干及分支显示不清分别为 12例、5例及 10例。左肾动脉开口、主干及分支显示不清分别为 8例、4例及 6例。 5 0例腹部CT增强扫描显示 :右肾动脉开口位于腹主动脉侧壁、侧前壁以及侧后壁分别为 4例、2 4例及 3例。左肾动脉开口位于腹主动脉侧壁、侧前壁以及侧后壁分别为 13例、2例及 13例。两肾动脉开口位于腹主动脉同一水平面 11例。 16例旋转肾动脉DSA中 ,两侧肾动脉旋转 6例 ,单侧肾动脉旋转 10例。肾动脉开口狭窄 3例 ,主干狭窄 2例 ,肾肿瘤供血动脉 7例 ,排除肾动脉狭窄 4例。结论　旋转肾动脉DSA有助于详细显示肾动脉的解剖细节。     

不明原因消化道出血的DSA诊断(附22例报告)

目的：评价ＤＳＡ对不明原因消化道出血的诊断作用。方法：２２例不明原因的消化道出血患者进行ＤＳＡ检查,其中１７例经手术病理证实。结果：１４例ＤＳＡ发现病变,阳性率６３．６％,８例未发现异常。在１４例ＤＳＡ阳性患者中肿瘤６例,血管畸形５例,静脉曲张１例,溃疡１例,多发性息肉１例。８例ＤＳＡ阴性患者６例进行了手术探查,共５例发现病变,其中憩室２例,溃疡、息肉和腺瘤各１例。结合手术情况,在总结１９例阳性病例中有１０例病变位于小肠。结论：小肠疾病是引起不明原因消化道出血的主要原因,其中以肿瘤性病变多见。ＤＳＡ是诊断不明原因消化道出血的一种有用的方法     

消化道出血DSA检查影响图像质量因素的探讨

目的 探讨消化道出血DSA检查影响图像质量的因素。资料与方法 对26例消化道出血患者均行腹腔动脉、肠系膜上动脉、肠系膜下动脉DSA检查。根据情况对部分患者行超选择性DSA检查。结果 26例中，23例获得满意的DSA检查效果，出血部位和原因诊断清楚，通过介人治疗成功地达到了止血目的；3例未能明确诊断消化道出血。结论 良好的DSA检查效果是消化道出血诊断与治疗的基础。     

胃肠道血管畸形的临床与DSA特征（附11例分析）

目的：研究胃肠道血管畸形的临床和ＤＳＡ特点。材料与方法：回顾性分析１１例胃肠道血管畸形患者的临床及ＤＳＡ表现。其中男性７例，女性４例。所有患者均作选择性肠系膜上、下动脉及腹腔动脉造影。结果：该病具有以下临床和ＤＳＡ特点：（１）临床特点：①多为中老年患者；②以反复发作的慢性间歇性消化道出血（黑便或便血）为主要症状；③常规检查一般阴性。（２）ＤＳＡ特点：①出现异常增多的细小血管，或伴扩张的供血动脉，此     

不明原因消化道出血的血管造影及介入治疗

目的：探讨不明原因消化道出血血管造影和介入治疗的方法及临床价值。方法：不明原因消化道出血血管造影23例，男16例，女7例。介入治疗7例，分别进行血管加压素灌注止血和明胶海绵、不锈钢圈栓塞治疗。结果：血管造影阳性病例16例，其中炎症出血3例（小肠2例、结肠1例），小肠憩室5例，小肠血管畸形4例，肿瘤4例（小肠3例、胃癌1例）；造影阴性7例。介入治疗7例，其中4例血管加压素灌注止血、明胶海绵栓塞2例、不锈钢圈栓塞1例。结论：血管造影时应尽可能将导管超选择插入相应的可疑异常血管分支，提高不明原因消化道出血的检出阳性率，并同时进行介入治疗。     

Use of Provocative Angiography to Localize Site in Recurrent Gastrointestinal Bleeding

Background While the source of most cases of lower gastrointestinal bleeding may be diagnosed with modern radiological and endoscopic techniques, approximately 5% of patients remain who have negative endoscopic and radiological investigations [1]. Clinical Problem These patients require repeated hospital admissions and blood transfusions, and may proceed to exploratory laparotomy and intraoperative endoscopy. The personal and financial costs are significant. Method of Diagnosis and Decision Making The technique of adding pharmacologic agents (anticoagulants, vasodilators, fibrinolytics) during standard angiographic protocols to induce a prohemorrhagic state is termed provocative angiography. It is best employed when significant bleeding would otherwise necessitate emergency surgery. Treatment This practice frequently identifies a bleeding source (reported success rates range from 29 to 80%), which may then be treated at the same session. We report the case of a patient with chronic lower gastrointestinal hemorrhage with consistently negative endoscopic and radiological workup, who had an occult source of bleeding identified only after a provocative angiographic protocol was instituted, and who underwent succeeding therapeutic coil embolization of the bleeding vessel.     

Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

Objective

To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding.

Materials and Methods

Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1-1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated.

Results

The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18).

Conclusion

TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy.     

Nonvariceal Upper Gastrointestinal Bleeding: the Usefulness of Rotational Angiography after Endoscopic Marking with a Metallic Clip

Objective

We wanted to assess the usefulness of rotational angiography after endoscopic marking with a metallic clip in upper gastrointestinal bleeding patients with no extravasation of contrast medium on conventional angiography.

Materials and Methods

In 16 patients (mean age, 59.4 years) with acute bleeding ulcers (13 gastric ulcers, 2 duodenal ulcers, 1 malignant ulcer), a metallic clip was placed via gastroscopy and this had been preceded by routine endoscopic treatment. The metallic clip was placed in the fibrous edge of the ulcer adjacent to the bleeding point. All patients had negative results from their angiographic studies. To localize the bleeding focus, rotational angiography and high pressure angiography as close as possible to the clip were used.

Results

Of the 16 patients, seven (44%) had positive results after high pressure angiography as close as possible to the clip and they underwent transcatheter arterial embolization (TAE) with microcoils. Nine patients without extravasation of contrast medium underwent TAE with microcoils as close as possible to the clip. The bleeding was stopped initially in all patients after treatment of the feeding artery. Two patients experienced a repeat episode of bleeding two days later. Of the two patients, one had subtle oozing from the ulcer margin and that patient underwent endoscopic treatment. One patient with malignant ulcer died due to disseminated intravascular coagulation one month after embolization. Complete clinical success was achieved in 14 of 16 (88%) patients. Delayed bleeding or major/minor complications were not noted.

Conclusion

Rotational angiography after marking with a metallic clip helps to localize accurately the bleeding focus and thus to embolize the vessel correctly.     

动脉法DSA在脑部疾病诊断中的应用

本文报道了我院50例经皮股动脉穿刺,单支导管选择性全脑DSA的应用情况。对于操做方法及其体会作了详细的介绍。通过分析讨论认为动脉法DSA对于脑部多种疾病的诊断、特别是脑血管性病变的诊断有着不可取代的作用,并较之普通脑血管造影有更多的优越性。