不明原因消化道出血的血管造影诊断与手术病理对照研究

目的 探讨选择性血管造影对不明原因消化道出血的诊断价值。方法 32例急性或慢性反复消化道出血患者，其中上消化道出血26例，下消化道出血6例，全部病例经Seldinger’s法靶动脉插管DSA或／和PUCK造影。结果 定位诊断率为84．38％（27／32例），与手术诊断的符合率为78．95％（15／19）。病变性质为：肿瘤性病变9例，血管性病变15例，其中血管畸形9例、肠小动脉瘤2例、胆囊动脉瘤破裂出血1例、动脉硬化3例；非特异性炎症溃疡3例，造影阴性5例。直接显示出血征象（造影剂外溢）23例（71．87％）。结论 选择性血管造影对不明原因的急慢性消化道出血的定位、定性诊断有肯定价值，尤其对小肠和胆出血病变的诊断更具独特的优越性。

Selective angiographic diagnosis of unknown reason gastrointestinal hemorrhage: Correlation with pathology

Objective To evaluate the diagnostic value of selective angiography for unknown reason gastrointestinal hemorrhage. Methods 32 patients with acute or chronic gastrointestinal recurrent hemorrhage were examined. Among them, 26 patients had upper gastrointestinal hemorrhage and 6 with inferior gastrointestinal hemorrhage. All patients were under gone DSA and/or Puck angiography with Seldinger's technique. Results The accuracy of localization was 84.38%(27/32) and the coincident rates with the operation or pathology was 78.95%(15/19). In all of patients, tumor of 9 case were shown and 15 cases of vascular diseases, namely, 9 with vascular malformation, 2 with small intestinal aneurysm, 3 with arteriosclerosis and 1 with broken gallbladder aneurysm; 3 cases of ulcer or nonspecific inflammation and 5 cases were negative. 23 cases (71.87%) showed the direct hemorrhagic sign, namely the contrast media extra vasation. Conclusions Selective angiography is very helpful for determining the location and the character of unknown reasoned acute or chronic gastrointestinal hemorrhage, especially for the hemorrhage of the small intestine and biliary tracts.