十二指肠溃疡出血的急诊介入栓塞治疗

目的探讨急诊经导管动脉栓塞术(emergency transcatheter arterial embolization,ETAE)在治疗十二指肠溃疡出血的临床疗效。方法 48例十二指肠溃疡出血患者行急诊动脉造影检查,明确出血部位后,采用栓塞弹簧圈、明胶海绵条、较大直径的丙烯酸微球(TAGM)和聚乙烯醇(PVA)颗粒对出血动脉行急诊栓塞治疗,对动脉造影表现及治疗效果进行回顾性分析。结果急诊动脉造影表现:胃十二指肠动脉出血35例(35/48);肠系膜上动脉动脉活动性出血8例(8/48);5例患者动脉血管造影未发现明确出血动脉(5/48),后转入外科行切除治疗;假性动脉瘤形成30例;明显造影剂外溢8例;胃十二指肠动脉痉挛变细5例。经ETAE治疗后,43例患者达到成功止血,技术成功率90%。2例患者术后再次出血,行第二次ETAE治疗后成功止血,术后随访12个月,所有经ETAE治疗后患者均未发现肠坏死及异位栓塞等严重并发症。结论 ETAE是治疗十二指肠溃疡出血的有效、安全、快速的治疗手段。     

血管栓塞治疗胃十二指肠动脉大出血(附5例报告)

胃十二指肠动脉大出血是上消化道出血原因之一 ,血管栓塞治疗是经导管行动脉造影 ,寻找出血动脉的同时进行相应出血动脉栓塞。具有操作简便 ,疗效迅速可靠的优越性。本文报道胃十二指肠动脉出血 5例 ,进行了血管栓塞治疗 ,取得了很好的疗效。1　典型病例介绍例 1　患者 ,女 ,72     

休克病人行胃十二指肠动脉栓塞止血的体会

目的 :探讨动脉性上消化道出血的休克病人经导管栓塞止血治疗的临床应用价值。方法 :3例十二指肠球部出血伴休克的病人 ,腹腔动脉造影示腹腔动脉显影差 ,经导管注入利多卡因后 ,腹腔动脉造影见腹腔动脉显影好 ,胃十二指肠动脉造影剂外渗 ,用明胶海绵栓塞胃十二指肠动脉。结果 :3例病人术后上消化道出血症状消失 ,胃镜检查未见上消化道出血。结论 :对于上消化道出血的休克病人 ,如能明确出血的部位和准确地推断出血的血管 ,在积极治疗休克的情况下 ,采用适量的非离子型造影剂和血管扩张剂选择性地行血管造影 ,不仅能显示出血的血管 ,而且能对其进行栓塞止血治疗。     

外伤性胰腺假性动脉瘤致胆道大出血治愈一例

外伤性胆道出血多见于严重肝外伤 ,因胰腺外伤性假性动脉瘤导致的胆道出血罕见 ,我院近期收治 1例。现报告如下。临　床　资　料患者 ,男 ,3 8岁。 1999年 6月 7日因上腹部被钢板撞伤致十二指肠破裂 ,在当地医院行剖腹探查、十二指肠修补术。术后半个多月出现上消化道大出血 ,经数字减影动脉造影术 (ＤＳＡ)检查 ,确诊胃十二指肠动脉胰内段有假性动脉瘤形成并出血 ,即行胃十二指肠动脉栓塞 ,出血停止。 2 0 0 0年 4月 3 0日后 ,患者反复出现上腹痛、上消化道出血、发热、黄疸 ,经再次行腹腔动脉及肠系膜上动脉ＤＳＡ检查 ,显示胃十二指肠动…     

奥美拉唑与雷尼替丁治疗十二指肠球部溃疡疗效观察

奥美拉唑和雷尼替丁均为治疗胃与十二指肠溃疡的有效药物。我院从１９９４～１９９６年用这２种药物治疗了典型的十二指肠球部溃疡１００例。现将疗效观察报告如下。１临床资料本组病例为１９９４年３月至１９９６年８月门诊患者。全部经胃镜明确诊断为十二指肠球部溃疡。...     

饮酒致飞行员上消化道出血2例

某部相继发生两例飞行员因节日饮酒,诱发上消化道大出血,现报告如下。 1 病例报告 例1男,34岁,飞行副大队长,飞行时间1200h。既往患慢性十二指肠球部溃疡,节日会餐,饮入38度白酒约200ml后胃部不适、疼痛、恶心,当夜11时至次日晨6时共排柏油便3次,量多。患者头昏、乏力、心慌、四肢发冷,血压12.0/6.6 kPa(90/50 mmHg),脉搏120次/min,血红蛋白68g/L。急送医院,经胃镜检查确诊为十二指肠球部溃疡出血。给予止血、输血、补液,病情稳定后出院。后发作2次,行胃大部切除而停飞。     

小儿胃十二指肠溃疡X线征象

目的:探讨小儿胃十二指肠溃疡的X线征象.方法:搜集经手术证实的54例胃十二指肠溃疡患儿的钡餐检查资料,年龄11天～14岁,平均10.4岁,其中男女之比约为2:1.分析小儿胃十二指肠溃疡的临床及X线表现.结果:54例中,胃溃疡6例(11%),十二指肠溃疡47例(87%),复合溃疡1例(2%).胃溃疡X线表现为龛影,黏膜改变,胃窦痉挛、狭窄及排空延迟.十二指肠溃疡X线表现为龛影,球部变形、黏膜改变、幽门管偏移、球部激惹征.结论:传统X线钡餐可诊断小儿胃十二指肠溃疡,其X线征象具有一定特异性.     

少见病因的上消化道大出血诊治

少见病因的上消化道大出血诊治武警广东总队医院二内科杨莉（广州５１０５０７）关键词上消化道出血，少见病因，诊断，治疗上消化道出血是临床常见而严重的症候，引起上消化道出血的病因很多，但常见病因为：十二指肠球部溃疡并出血，食道静脉曲张破裂出血及胃癌并出血。...     

中西医结合治疗胃及十二指肠球部溃疡120例

我院自１９９１年１月～１９９６年１２月用自拟溃疡散治疗胃及十二指肠球部溃疡１２０例，疗效满意，现报告如下。１临床资料１．１一般资料：经胃镜检查及胃粘膜组织检查，确诊为胃及十二指肠球部溃疡患者１２０例。其中男９６例，女２４例；年龄２２～６２岁，平均３６...     

疑难危重消化道大出血97例诊治体会

急性消化道大出血指短时间内大量呕血、便血 ,引起低血容量休克 ,甚至多脏器功能衰竭。由于发病急 ,出血量大 ,给诊断及治疗造成一定的困难。我科 1985～ 1999年收治疑难危重消化道大出血患者 97例 ,现报告如下。1　临床资料1.1　对象选择 :97例患者均因短时间内出现大量呕血和 /或黑便入院 ,既往无肝、胃、肠出血病史。男性 71例 ,女性 2 6例 ;年龄 18～ 73岁 ,平均 45 .4岁。1.2　出血原因与部位 :①上消化道出血 76例 :胃及十二指肠球部溃疡 2 5例 ,肝硬化 18例 ,胃癌 12例 ,胃Ｄｉｅｕｌａｆｏｙ病 8例 ,急性胃粘膜病变 4例 ,肝癌 3例 ,…     

Supraduodenal Branch of the Left Hepatic Artery: A Rare Cause of Bleeding Duodenal Ulcer

This is a case report describing a rare cause of massive duodenal ulcer hemorrhage resulting from the erosion of the supraduodenal branch of the left hepatic artery. This arterial branch is not a well known variation and is rarely recognized as a source of duodenal bleeding.     

医源性肝动脉出血的急诊栓塞治疗

目的探讨医源性肝动脉出血急诊肝动脉造影的表现及其栓塞治疗的疗效。方法对25例医源性肝动脉出血患者行急诊肝动脉造影,确定出血动脉后,以明胶海绵、PVA颗粒和弹簧圈进行急诊栓塞治疗,对医源性肝动脉出血急诊造影的表现及栓塞治疗的疗效进行回顾性的分析。结果14例患者肝动脉造影可见对比剂外溢,6例为肝动脉假性动脉瘤,5例为肝动静脉瘘。25例患者栓塞术后出血停止。栓塞治疗术后随访12个月。所有患者术后无再次出血及肝脏坏死及异位栓塞等严重并发症。结论急诊动脉栓塞治疗是治疗医源性肝动脉出血的一种安全、有效的微创方法。     

Pseudoaneurysm embolization and vasopressin infusion for lower gastrointestinal bleeding due to recurrence of urinary bladder carcinoma

We report a case that was successfully treated for massive lower gastrointestinal (LGI) bleeding due to a recurrent urinary bladder carcinoma. Treatment consisted of combination therapy including embolization of an inferior gluteal artery (IGA) pseudoaneurysm and low-dose arterial vasopressin infusion via a sigmoid artery (SA). A 57-year-old man presented with life-threatening sudden, massive LGI bleeding due to an obturator lymph node (LN) metastasis from a urinary bladder carcinoma. Computed tomography showed that the LN recurrence had invaded all the way to the sigmoid colon, and there was a pseudoaneurysm with extravasation inside the recurrence. An angiogram revealed a left IGA pseudoaneurysm. We therefore excluded the pseudoaneurysm by embolization with microcoils. Following this treatment the bleeding decreased, but intermittent LGI bleeding continued. Endoscopic examination showed the tumor with a huge ulcer inside the colonic lumen, and continuous oozing was confirmed. A second angiogram showed no recurrence of the IGA pseudoaneurysm and no apparent findings of bleeding. Then a 3F microcatheter was placed in the SA selectively using a coaxial catheter system, and vasopressin was infused at a rate 0.05 U/min for 12 h. Bleeding completely ceased 2 days later. There were no signs of ischemic gastrointestinal complications. Massive LGI bleeding has not recurred in 5 months.     

Interobserver variation in the radiographic diagnosis of duodenal ulcer disease

Interobserver variation was estimated in radiologists' detection of duodenal ulcer and deformity of the duodenal bulb. A consecutive series of 156 patients with upper abdominal pain had a double contrast barium examination. The films were first read by routine by a specialist in radiology. A second reading was performed by another specialist who did not know the result of the first reading. Overall agreement between the two readings in the detection of duodenal ulcer and deformity of the duodenal bulb was 0.91 and 0.94, respectively. The overall agreement was adjusted for the expected chance agreement and kappa values were calculated. Kappa was 0.63 for the detection of duodenal ulcer and 0.85 for the detection of deformity of the duodenal bulb.     

老年上消化道出血60例临床分析

目的 探讨老年上消化道出血的病因及治疗特点.方法 对2008年1月～ 2010年1月我院收治的老年上消化道出血病例进行分析.结果 胃溃疡出血26例(占43%),十二指肠球部溃疡出血8例(占13%),胃癌出血10例(占16%),食管静脉曲张破裂出血11例(占18%),Mallory-Weiss综合征2例(占3%),胆道出...     

十二指肠溃疡的螺旋CT诊断价值

目的：探讨螺旋CT诊断十二指肠溃疡的价值。材料和方法：回顾性分析1500例上腹部CT图像。结果：CT诊断十二指肠溃疡27例,经胃镜和胃肠双对比造影明确诊断18例,CT诊断准确率为66．7%。十二指肠溃疡常见的CT表现为肠壁增厚、管腔狭窄和球变形。结论：上腹部CT诊断十二指肠溃疡有一定价值,分析上腹部CT图像时,应注意十二指肠溃疡的可能。     

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.     

A case of rectal Dieulafoy’s lesion successfully treated by transcatheter arterial embolization

A 50-year-old man showed massive lower gastrointestinal bleeding without a triggering episode. An emergency colonoscopy revealed a protruding vessel in the lower rectum with no active bleeding. No underlying ulcer was seen within the surrounding mucosa. These findings were consistent with rectal Dieulafoy’s lesion. Angiography was requested to identify the source of bleeding and for possible embolization. On the initial angiography, the bleeding point was unclear. Abnormal vessels such as arteriovenous malformation or nidus were not found. He again developed hematochezia, requiring transfusion of red blood cells. However, the second colonoscopy showed no active bleeding from the protruding vessel in the rectum. During the second angiography, sudden bleeding occurred. Angiography showed extravasation of contrast medium from the distal branch of the superior rectal artery. Transcatheter arterial embolization was performed, and was very effective.     

十二指肠球部溃疡钡餐检查体位的评价

本文复习了1990年连续的上胃肠道钡餐检查1800例,显示十二指肠球部有典型溃疡龛影154例,我们发现只能由俯卧右前斜位显示的球部龛影为55.1%,水平和半立仰卧左后斜位为28.6%,水平和半立仰卧右后斜位为6.4%。这三种体位的组合配套能显示97.4%的球部龛影。     

腹部和盆腔动脉大出血的急诊介入治疗

目的 探讨急诊介入治疗腹部和盆腔动脉大出血的临床应用价值.方法 收集腹部和盆腔动脉出血患者67例.其中胃十二指肠动脉分支出血11例,肠系膜上动脉分支出血15例.肠系膜下动脉分支出血6例,肾动脉分支出血12例和髂内动脉分支出血23例.采用Seldinger穿刺技术从股动脉插管,先行靶动脉血管造影明确出血动脉,选用明胶海绵...