原因不明胃肠道出血的DSA

目的：进一步提高消化道出血的诊断率，探讨ＤＳＡ的应用价值。材料和方法：对３０例原因不明胃肠道出血病例行选择性腹腔动脉和肠系膜上、下动脉造影。在常规ＰＵＣＫ快速摄片后，再行ＤＳＡ，比较两种方法所见。结果：３０例中２４例发现病理血管，检出病变，检出率为８０％。其中肿瘤６例（胃肠平滑肌瘤或肉瘤５例，腺瘤１例），血管病变１１例（ＡＶＭ６例，小肠毛细血管扩张症４症，胃底静脉曲张１例）；炎症性病变６例（麦克尔憩室２例，胆道出血１例，胃溃疡或糜烂３例）和十二指肠粘膜异位１例。ＤＳＡ较常规血管造影片显示病变更清楚，血管结构更仔细。２例小肠毛细血管扩张症在常规血管造影片上仅见小血管密集，紊乱，而ＤＳＡ则能清楚显示病变肠段较正常肠段染色异常增浓，因此术前得以确诊。本组资料显示ＤＳＡ对于提高胃肠道出血的病变检出率和诊断正确率很有价值。１例小肠毛细血管扩张症出血第一次检查阴性。一周后采用山莨菪碱药物血管造影，ＰＵＣＫ及ＤＳＡ见造影剂外溢及肠管异常染色而得到诊断。结论：胃肠道出血的血管造影检查结合应用ＤＳＡ，可进一步提高病变检出率和诊断正确率。

Value of DSA Examine in Unknown Gastrointestinal Bleeding

Purpose:To improve the diagnosis of the unknown bleeding in gastrointestinal tract and to evaluate the value of DSA.Materials and methods:Separately selective angiography of the cealiac artery,the superior or the inferior mesentery artery were performed to 30 cases of unknown bleeding in gastrointestinal tract.After the puck films, the DSA were taken again to compare the findings of both methods.Results:24 cases among 30 cases were found the abnormal vessel to detect the lesion.The rate of detection was 80%.Tumor were 6 cases(leiomyoma or leiomyosarcoma 5 ,adenoma 1).Vascular lesion were 11 cases(AVM 6,small intestinal telangiectasia 4,gastric varices 1).Inflammatory lesion were 6 cases(Meckel's diverticulum 2,biliary bleeding 1,ulcer or inflammation 3).Aberrant duodenal mucosa are 1 case.To compare the puck film,DSA were more clear and more detail to show the abnormal vessel.Two cases of telangiectasia were only found small vessel increased and confused in puck film but were found additional dense stain at the abnormal intestinal segment in DSA so that the correct diagnosis was made up.Our materials show that it is valuable for DSA to improve the sensitivity and accuracy to diagnose the gastrointestinal bleeding.A small intestinal telangiectasia was not found at first examination.After one week,repeat examination was performed by using Anisodamine pharmaco-angiography.There was the contrast extravasation and abnormal stain in both puck film and DSA.Conclusion:In angiography to examine the gastrointestinal bleeding,It will be useful to improve the sensitivity and accuracy to combine puck film and DSA.