急诊内镜联合选择性动脉造影诊治上消化道大出血：7例临床分析

背景：上消化道大出血属急危重症，联合多种诊治手段有助于提高救治效果。目的：探讨急诊内镜联合选择性动脉造影在上消化道大出血诊治中的应用价值。方法：选取2009年1月～2010年12月北京军区总医院经急诊内镜止血失败或止血成功后再次大出血的7例患者并给予选择性动脉造影和栓塞治疗。观察急诊内镜联合选择性动脉造影对明确病因诊断和止血效果的价值。结果：7例患者行急诊内镜检查确诊为上消化道大出血．并经镜下止血治疗后仍有严重活动性出血．行选择性动脉造影和栓塞治疗。7例患者就诊后行急诊内镜的平均时间为4．4h．选择性动脉造影平均时间为8．4h。4例患者表现为造影剂外溢的出血直接征象．其余3例表现为异常血管分支增粗紊乱的间接征象；给予弹簧圈栓塞或明胶海绵栓塞治疗后均成功止血。结论：急诊内镜联合选择性动脉造影是一种及时、安全、有效的诊治上消化道大出血的方法。

Emergency Endoscopy Combined with Selective Arteriography in Diagnosis and Treatment of Upper Gastrointestinal Massive Bleeding: Clinical Analysis of 7 Cases

Background: Upper gastrointestinal massive bleeding is one of urgent and severe diseases.Combining a variety of diagnosis and treatment methods is helpful for improving therapeutic efficacy.Aims: To evaluate the value of emergency endoscopy combined with selective arteriography in diagnosis and treatment of upper gastrointestinal massive bleeding.Methods: Seven patients with upper gastrointestinal massive bleeding who failed to achieve hemostasis by emergency endoscopy and then underwent selective arteriography were enrolled from Jan.2009 to Dec.2010 at Beijing Military General Hospital.The value of emergency endoscopy combined with selective arteriography in detecting cause of bleeding,and the efficacy of hemostasis were analyzed.Results: Seven patients with upper gastrointestinal massive bleeding were diagnosed by emergency endoscopy,and severe active bleeding still occurred after hemostasis intervention at endoscopy,then selective arteriography and embolotherapy were performed in these patients.The mean time intervals between the visit at emergency department and emergency endoscopy,and selective arteriography were 4.4 and 8.4 hours,respectively.Four patients showed direct bleeding signs by contrast agent extravasation during selective arteriography,and indirect signs(coarse and bizarre blood vessel branches) were seen in 3 cases.All the patients had their bleeding successfully stopped after embolotherapy with spring coil or gelatin sponge.Conclusions: Emergency endoscopy combined with selective arteriography is a timely,effective and safe method for diagnosis and treatment of upper gastrointestinal massive bleeding.