不明原因消化道大出血急诊选择性内脏血管造影及介入治疗的临床价值

目的 探讨不明原因消化道大出血急诊选择性内脏血管造影诊断及介入治疗的临床应用价值。方法 1992—2002年期问对25例不明原因消化道大出血患行急诊选择性内脏血管造影，其中20例灌注血管收缩剂，5例予以经导管栓塞术。结果 显示出血灶23例(92．0％)，表现为造影剂外溢征(15例)、新生肿瘤血管和肿瘤染色征(15例)以及动静脉畸形(2例)。5例经导管栓塞治疗，获永久性止血；20例灌注血管收缩剂治疗后24h复发出血1例。造影后17例手术，其中急诊手术6例、择期手术11例；术前血管造影与外科术后诊断符合率为88．2％。未出现并发症。结论 急诊选择性内脏血管造影诊断及介入治疗，对不明原因消化道大出血有较大的临床实用价值且安全可行。

Value of emergency selective angiography in massive hemorrhage of unknown cause in digestive tract

Objective To discuss the efficacy of emergency selective angiography and interventional therapy on the digestive tract hemorrhage with unknown cause. Methods From 1992 to 2002, emergency selective visceral angiography was performed in 25 cases of the digestive tract bleeding with unknown causes. Five of them were treated by transcalheter embolization and the other 20 patients were treated by vasopressin infusion. Results The sites of bleeding were identified by angiography in 23 patients(92. 0% ) . Angiograms demonstrated contrast medium leakage in 15, tumor vessels and tumor staining in 15, and artery and vein malformation(AVM) in 2 cases. Bleeding was controlled permanently in five cases after transcatheter embolization, and recurred in only one of the 20 cases treated by vasopressin infusion. Operations were performed in 17 of the 25 cases, including emergency operations in 6 and scheduled operations in 11 cases. The accuracy rate of the preoperative angiography diagnosis in comparison with the postoperative diagnosis was 88. 2%. No complications occurred. Conclusions Emergency selective visceral angiography is of great value in the diagnosis and localization of acute gastrointestinal bleeding. Transcatheter interventional treatment is a safe and efficient therapy.