肠动静脉畸形诊断和标记定位问题——附38例报告

肠动静脉畸形为消化道出血重要原因。应用肠系膜动脉造影诊断并同时置标记物作为病人手术定位以减少术中盲目性。材料和方法:选择性肠系膜动脉造影,术前诊断38例小肠动静脉畸形,其中10例放置导引钢丝或造影导管,作为术中定位标记,并即刻或择期手术。结果:本组动脉造影X线表现为:(1)动静脉瘘和静脉早显21例;(2)局部染色浓密30例,(3)局部异常增多的血管丛30例;(4)肠壁内静脉扩张,迂曲27例。38例病理检查,仅2例为炎症,诊断符合正确率95％。10例置标记物者,术中顺利寻找并切除病灶。结论:选择性肠系膜动脉造影是诊断该病的最可靠方法,同时放置标记物能帮助外科医师顺利寻找并切除病变,且无并发症。该方法是一全新的定位方法,值得推广。

Diagnosis of IAVM and Placement of Location Mark: Report of 38 Cases

Aims:Intestinal arteriovenous malformation(IAVM) is one of the common causes of intestinal occult bleeding. The selective mesentery artery angiography diagnosis with placement of mark for lesion location may decrease the blindness in surgical intervention. Materials and Methods: Selective mesentery artery angiography were made in 38 patients with IAVM, and in 10 of which, a segment of guide wire or catheter itself was placed simultaneously as location mark. Results: The principal angiographic features of this disease as: 1. Arterio-venous shunt and early appearance of drainage veins in 21 cases; 2. Focal abnormal increase of vessel clumps 30; 3. Focal dense stain 30; 4. Dilated and tortuous veins in intestinal wall 27 cases. In 2 of 38 operated patients, the histological results were of inflammation, so the accuracy rate was 95%. No intestinal ischemia changes resulting from the placement of location mark were found during operation in 10 patients. Conclusions: Selective angiography is the best method in diagnosis of IAVM at present. Placement of location mark can help surgeon greatly in finding and resecting the lesion successfully without complication. It is a new method and should be widely spread.