DSA在下消化道出血诊断中的应用策略

目的探讨肠系膜动脉DSA在下消化道出血诊断中的应用策略。方法回顾性分析结肠镜检查为阴性结果的下消化道出血患者36例,其中8例为急性大出血,28例为慢性出血;对所有患者均行肠系膜上、下动脉及腹腔动脉DSA检查。结果 DSA发现6例病变,阳性率为16.67%(6/36)。5例病变位于小肠,其中3例可见对比剂外溢等直接出血征象,手术证实为小肠憩室;1例表现为血管局部囊状扩张,伴对比剂外溢,手术证实为小肠动脉瘤破裂出血;1例表现为空回肠段静脉早显、异常血管湖,诊断为血管扩张。1例病变位于结肠,表现为肿瘤染色,手术证实为间质瘤。结论肠系膜动脉DSA对于诊断结肠镜阴性的下消化道出血、特别是对于结肠镜难以观察的小肠病灶所致出血具有一定价值。

Application strategy of DSA in diagnosis of lower digestive tract hemorrhage

Objective To explore the application strategy of DSA for mesenteric artery in diagnosis of lower digestive tract hemorrhage. Methods Thirty-six patients of lower digestive tract hemorrhage with negative colonoscopy results were retrospectively analyzed, including 8 patients of acute massive hemorrhage and 28 patients with chronic hemorrhage. DSA of superior mesenteric artery, inferior mesenteric artery and celiac artery were performed in all patients. Results DSA discovered abnormalities in 6 patients (6/36, 16.67%). Hemorrhage located in small intestine in 5 patients, while in colon in 1 patient. Among 5 patients with small intestine hemorrhage, contrast medium extravasation was found in 3, in whom diverticula was confirmed after surgical operation. Vessel cystic dilatation and contrast medium extravasation were observed in 1 patient of small intestine hemorrhage, and aneurysm was confirmed after surgical operation. Early opacification of veins and abnormal blood lakes were detected in the rest one patient of small intestine hemorrhage, who was finally diagnosed vascular ectasia. Obvious tumor stain was found in one patient of colon hemorrhage, who was diagnosed as gastrointestinal stromal tumor after surgical operation. Conclusion DSA for mesenteric artery is valuable for detection lower digestive tract hemorrhage which is not diagnosed by colonoscopy, especially for lesions locating in small intestine.