介入诊疗在急性出血的应用价值

目的探讨介入诊疗对急性出血的诊断与治疗价值。 方法对67例急性出血的患者采用介入治疗，行选择性及超选择性动脉造影和血管内栓塞术，其中上消化道出血28例，下消化道出血12例，子宫出血17例，肝肾出血5例，急性咯血1例，术后急性腹腔内出血4例。 结果67例患者经一次选择性动脉造影获得明确诊断66例，诊断阳性率98.51%(66/67)。选择性动脉造影显示对比剂外溢出血直接征象37例，直接征象阳性率55.22%(37/67)。发现假性动脉瘤13例，肿瘤供血动脉及肿瘤染色21例，子宫瘢痕染色及孕囊染色12例，血管结构不良出血1例。诊断明确后均成功止血。1例消化道出血患者，介入栓塞治疗4天后复发出血，经第二次选择性动脉造影及介入栓塞侧支供血后成功止血。一次性栓塞治疗成功率98.51%(66/67)。 结论选择性动脉造影及血管内栓塞术对急性出血可明确出血部位，而且可迅速有效止血，是一种安全易行、迅速有效的诊断与治疗手段。

Diagnostic and treatment value of interventional radiology in acute hemorrhage

ObjectiveTo explore the value of interventional diagnosis and treatment for the acute hemorrhage. MethodsA total of 67 patients with acute bleeding were performed with arteriography and endovascular embolization, In which, 28 cases with the upper gastrointestinal bleeding, 12 with the lower gastrointestinal bleeding, 17 with the uterine bleeding, 5 with the hepatic or renal bleeding , 1 with the hemoptysis and 4 with the postoperative acute bleeding. ResultsBy the way of selective arteriography, 66 cases were diagnosed successfully. The rate of positive diagnosis was 98.51% (66/67). The direct sign of bleeding was shown in 22 cases, which were extravasation of contrast media, the positive rate was 55.22% (37/67). Pseudoaneurysm was shown in 13 cases. The tumor blood feeding branches and tumor staining were seen in 21 cases. The scar and progesterone sac staining in uterine were seen in 12 cases. The vascular dysplasia was seen in 1 case. The immediate embolization was succeeded in all diagnosed cases, however, a patient with gastrointestinal bleeding relapsed after 4 days of embolization and was successfully treated by the second treatment. The effective rate of hemostasis was 98.51% (66/67). ConclusionsSelective angiography and intravascular embolization for acute hemorrhage can clear the acute bleeding site as well as achieving rapid hemostasis, which is a safe, easy and cost-effective method.