医护良好配合抢救急性腹部大出血

目的：探讨医护良好配合对抢救急性腹部大出血的意义。方法66例急性腹部大出血患者,急症行血管造影检查及血管内栓塞治疗。结果本组66例患者经积极介入诊疗,医护密切配合及优质护理,经1次选择性动脉造影获得明确诊断65例,诊断阳性率98．5％。明确诊断后,一次性栓塞治疗成功率98．5％。1例消化道出血患者,介入栓塞治疗4天后复发,经第二次选择性动脉造影及介入栓塞侧枝供血后成功止血,未出现相关并发症。结论急性腹部大出血的抢救成功与否及治疗效果好坏,不仅与术者技术有关,还与护理水平、医护配合密切相关。优质的护理,对保证介入手术顺利、成功,减少和防止并发症,缩短住院时间具有重要作用。     

急性动脉性出血介入诊疗的临床应用

目的:评价急性动脉性出血介入诊疗术的临床应用价值。方法:采用改良Seldinger技术,经股动脉穿刺插管对260例急性动脉性出血(包括蛛网膜下腔出血、鼻出血、咯血、消化道出血、外伤出血、肿瘤出血、产后出血等)病例进行选择性血管造影,并对其中240例进行栓塞治疗、8例进行血管加压素灌注治疗。结果:经选择性血管造影,260例急性动脉性出血病例中252例发现出血征象,8例无明显异常发现,诊断阳性率为96.9%。8例经导管灌注药物治疗,止血有效率为50%;240例栓塞治疗,止血有效率为95%,本组止血总有效率为93.5%,全部病例均无严重并发症发生。结论:选择性血管造影是急性动脉性出血最确切的诊断方法;介入治疗是急性动脉性出血的安全、有效的治疗方法,并且并发症少,有重要的临床应用价值,对于少数病例虽然不能永久止血,但可为临床进一步治疗争取时间。     

急性消化道大出血的血管内介入治疗

目的：研究血管介入技术对急性消化道大出血的诊断和治疗价值。材料和方法：对59例急性消化道大出血患者进行动脉造影,发现出血征象时超选并采用钢圈配合海绵颗粒进行栓塞治疗。结果：59例造影发现出血阳性征象28例,栓塞治疗25例,止血成功21例,成功率84%。最终转外科手术10例。结论：动脉造影及栓塞技术可以作为消化道大出血的一项重要诊断及治疗措施。     

急性消化道出血的血管造影诊断与介入治疗

目的:探讨急性消化道出血的血管造影诊断的价值及介入治疗的方法和意义。方法:26例急性消化道出血,经选择性血管DSA检查,并对其中14例,经导管动脉灌注垂体后叶素或栓塞治疗。结果:阳性19例,阴性7例。14例经介入治疗后,11例得到完全止血,2例止血不彻底,1例48h后再出血。结论:选择性血管造影对急性消化道出血,特别是小肠部位的出血定位、定性诊断有肯定的价值;合理选择造影时机,可以提高对出血检出的阳性率;并经导管动脉灌注垂体后叶素或栓塞治疗后,止血迅速有效。     

消化道大出血的介入应用

目的：探讨消化道大出血的介入诊断及治疗价值。资料与方法：对14例消化道出血病例进行血管造影，术中根据不同的出血原因和部位，分别采用动脉栓塞或缩血管药物、止血药物的灌注治疗。结果：动脉栓塞治疗4倒，即时止血率为100％；缩血管药物加止血药物灌注8例，即时止血率100％。1例24小时内再出血；2例进行血管造影明确诊断，行外科手术。治疗术后病人均无严重并发症。结论：消化道出血介入治疗，可明确诊断确定出血点，术中同时行动脉栓塞或缩血管药物、止血药物灌注治疗是安全有效的，为临床诊断及治疗提供了帮助；若复发出血，亦可为急诊病人争取时间。     

胃十二指肠动脉假性动脉瘤血管造影诊断及栓塞治疗

目的探讨血管造影诊断及栓塞治疗胃十二指肠动脉假性动脉瘤的方法。资料与方法12例胃十二指肠动脉假性动脉瘤均为腹部外科手术后急性消化道出血,经内科保守治疗无效而急诊行血管造影及栓塞治疗。其中消化道出血前2例有感染征象,2例腹腔引流液淀粉酶升高。结果11例栓塞后迅速止血;1例消化道出血栓塞胆囊动脉6h后再出血,再次造影发现胃十二指肠动脉残端假性动脉瘤破裂,栓塞胃十二指肠动脉残端后止血。栓塞后复查造影示假性动脉瘤供血动脉完全闭塞,假性动脉瘤未见显影;栓塞术后3例有一过性上腹部疼痛。术后随访3～46个月,无复发及并发症。结论血管造影诊断及经导管栓塞是诊断及治疗胃十二指肠动脉假性动脉瘤迅速、安全、有效的方法。     

选择性动脉栓塞术在医源性出血中的应用

目的：探讨选择性动脉栓塞术在治疗医源性出血中的临床应用价值。方法回顾性分析32例医源性出血患者资料,首先经皮选择性动脉造影,明确出血部位及特点,然后超选择性介入栓塞止血,栓塞材料选择明胶海绵、线段、弹簧圈及 PVA 颗粒等。结果32例患者中26例血管造影发现活动性出血征象,主要表现为对比剂外溢,伴有假性动脉瘤6例,伴有动静脉瘘1例,均成功施行介入栓塞止血,仅1例术后8 d 再次出血行二次栓塞治疗。本组病例术后随访1月,25例患者未出现严重并发症,1例多脏器功能衰竭死亡。6例血管造影阴性患者,3例失血性休克死亡,3例经内科治疗出血停止。结论选择性动脉栓塞术在医源性出血治疗中是一种安全、有效的措施。     

急性消化道出血的血管造影及介入栓塞治疗

目的：研究消化道出血的血管造影诊断及介入栓塞治疗的方法和价值。方法：报告26例急性消化道出血的患者，采用Seldinger技术进行血管造影诊断及导管介入栓塞治疗。栓塞剂使用明胶海绵和弹簧圈。结果：26例中23例明确了出血部位和出血原因，其中上消化道出血17例，下消化道出血6例，病变性质为：肿瘤性病变2例，血管性病变13例，非特异性炎症溃疡8例，造影阴性3例。23例中21例栓塞后即刻止血，动脉栓塞成功率为91．3％，无胃肠道坏死等并发症发生。结论：动脉造影对消化道出血的定位及定性有重要的价值，动咏栓塞治疗是安全、有效的止血措施。     

下消化道出血的选择性动脉造影诊断及栓塞治疗

目的 探讨下消化道出血的选择性造影表现及介入治疗的疗效。方法 1996年2月～2002年2月间，对42例下消化道出血患行选择性动脉造影，并对其中15例诊断明确患行灌注或栓塞治疗。结果 明确出血部位及病变30例，诊断准确率71．4％(30／42)，30例中，小肠出血10例，大肠20例；对其中3例肠道血管畸形患行明胶海绵栓塞治疗，成功率100％；12例行动脉内血管加压素灌注，8例出血停止，4例无效，有效率66．7％。结论 选择性血管造影是诊断下消化道出血最有效可靠的检查手段，动脉内介入治疗是一种有效的止血方法。     

胆囊切除术后出血的血管造影与介入治疗体会

目的研究胆囊切除术后腹腔出血选择性动脉造影的诊断价值及介入治疗的方法和意义。方法经选择性动脉DSA后明确胆囊切除术后出血部位共9例。对明确出血部位的5例行出血动脉栓塞术。造影阴性4例转行外科手术。结果9例中5例有血管异常改变,均为动脉性出血,表现为对比剂外溢,行靶血管栓塞术后出血停止,无复发。4例造影阴性,行外科剖腹探查术明确为静脉性出血后止血治愈。结论胆囊切除术后动脉性腹腔出血的患者DSA检查对诊断出血部位指导介入栓塞治疗有重要的临床价值。介入栓塞治疗安全、有效。     

超选择动脉栓塞术治疗动脉性消化道出血

目的讨论超选择动脉栓塞术对急性消化道出血的治疗作用。方法对31例急性消化道出血患者行动脉造影,发现出血征象时进行超选择插管并采用钢圈配合明胶海绵颗粒进行栓塞治疗。结果动脉造影表现为对比剂外溢,假性动脉瘤,血管畸形,肿瘤染色等。栓塞治疗30例,止血成功23例(其中7例行第2次栓塞),成功率76.7%。最终转为外科手术10例。结论超选择动脉栓塞术可有效治疗动脉性消化道出血,是外科治疗的重要补充措施。     

Transcatheter arterial embolization of acute upper gastrointestinal tract bleeding with N-butyl-2-cyanoacrylate

PURPOSEl: To retrospectively analyze outcomes in patients who received an iodized oil formulation of N-butyl-2-cyanoacrylate to treat acute nonvariceal upper gastrointestinal tract bleeding. MATERIALS AND METHODS: Sixteen patients with acute upper gastrointestinal tract bleeding underwent angiography and transarterial embolization between April 2004 and December 2005. Patients with negative findings at arteriography and those with lesions in large vessels that did not necessitate a microcatheter for catheterization were excluded. Three types of embolization were used according to the accessible arteries: Localized embolization was used in the bleeding artery, and distal (segmental) or proximal embolization was used in the parent artery according to the final position of the catheter tip. Outcomes, including hemostasis, recurrent bleeding, and complications, were recorded. RESULTS: Immediate hemostasis was achieved in 14 patients (88%). One (6%) patient had technical failure due to arterial dissection, and one (6%) patient had therapeutic failure due to multiple ulcers and coagulopathy. Of the 14 patients with immediate hemostasis, one (7%) had recurrent bleeding 5 days after embolization. Both patients in whom hemostasis was not achieved (12%) died within 1 month of follow-up. Multiple gastric ulcers were seen in two (12%) patients who underwent embolization of a large area, and conservative treatment was sufficient. CONCLUSIONS: The results of this preliminary experience indicate that transarterial embolization with the iodized oil formulation is feasible and effective in the management of nonvariceal upper gastrointestinal tract bleeding; however, a larger number of cases should be investigated.     

下消化道出血的诊断与介入治疗

目的：探讨介入方法在下消化道出血的诊断和治疗中的价值。方法：对11例经过内及钡剂检查来明确出血原因和部位的消化道出血患者，进行选择性动脉造影，通过显示对比例外溢、病理血管和肿瘤染色来确定出血原因及部位。同时对出血处用胶海棉栓塞或用保留导管灌注血管加压素止血。结果：全组11例，其中10例见对比剂外溢1例同时见肿瘤染色，7例显示病理血管。1例未能明确诊断。3例用明胶海棉栓塞治疗，8例采用保留导管灌汪血管加压素治疗，均达到止血效果。结论：介入治疗下消化道出血，可以快速作出定位诊断，且止血效果好，见效快，并发症少，既安全又可靠。     

Transcatheter embolization in the management of pulmonary hemorrhage

A group of 306 patients with acute pulmonary hemorrhage were evaluated by means of bronchial arteriography and treated with transcatheter embolization. Specific causes for bleeding included lung abscess, chronic pneumonia, tuberculosis, lung cancer, and bronchiectasis. In 120 patients the hemoptysis was massive, with volumes exceeding 500 ml/day. The majority (n = 225) were treated during peak hemorrhage. Embolization was performed with one of three methods: particulate embolization with polyurethane or velour, obturation with the angiographic catheter combined with peripheral embolization by means of infused albumin macroaggregates, and regional infusion of sclerosing agents. Effective hemostasis was obtained initially in 278 patients (90.8%), including 87.5% of those treated during peak hemorrhage. In 26 of 28 cases without initial response, the pulmonary artery was the source of bleeding. Recurrent bleeding, within 1-4 days, requiring surgery was observed in 39 patients with initially successful hemostasis. Of 158 patients who were treated without surgery, subsequent episodes of hemoptysis occurred in 36. Combined methods of embolization may improve the efficacy of treatment of operable and inoperable patients with lung disease complicated by hemorrhage.     

Transcatheter embolization for acute lower gastrointestinal hemorrhage

PURPOSE: The authors review their experience using transcatheter embolization in the treatment of acute lower gastrointestinal hemorrhage. MATERIALS AND METHODS: A retrospective review was conducted on 17 patients who underwent superselective transcatheter embolization for an acute lower gastrointestinal hemorrhage. All 17 patients were followed clinically 4 days to 60 months (mean, 18.5 months) after embolization for the presence of ischemia or for recurrent bleeding. In addition, 12 of 17 patients were examined 1 day to 12 months (mean, 38.8 months) after embolization by means of colonoscopy or by pathologic review. RESULTS: Transcatheter embolization achieved immediate hemostasis in 15 of 17 patients (88%) and was the definitive treatment in 76%. The other two patients underwent successful surgical resections after incomplete hemostasis of cecal lesions. Two patients of the 15, with initially successful embolizations, had recurrent hemorrhage within 30 days; both underwent further embolization with one failure. No intestinal infarction or stricture developed in the 15 patients who underwent successful embolization. CONCLUSIONS: The authors' experience supports the role of transcatheter embolization as a primary means of therapy for patients with an acute lower gastrointestinal hemorrhage. Their data further supports growing evidence that superselective embolization may be most efficacious in reducing complication rates.     

介入治疗在肝破裂出血中的应用

目的探讨介入治疗法在肝破裂(包括创伤性肝破裂和自发性肝破裂)中的应用。方法12例肝破裂出血患者的介入治疗是采用股动脉穿刺,肝动脉造影,以及靶血管(有活动性出血的血管)栓塞的治疗方法。结果12例造影有9例明确靶血管,3例显示肝表面不规则出血。12例均行栓塞治疗,其中,2例在48h内行两次栓堵。介入治疗后72h内随访观察,出血明显减少,血压趋于稳定。其中,9例痊愈出院,1例死于并发损伤,1例死于并发症,1例死于介入治疗后两周再次出血。结论介入治疗相对于外科手术具有操作简单、快捷、安全且创伤小等优点,是治疗肝破裂出血的一种有效方法。