血管造影阴性的消化道大出血再次造影及介入治疗的价值

目的:探讨再次血管造影和介入治疗在首次血管造影阴性的消化道大出血中的临床应用价值。方法:对43例首次血管造影阴性并经介入治疗后再次出血1-6 h内行超选择性血管造影,小肠、结肠出血或可疑出血于肠系膜上、下动脉灌注收缩剂,胃十二指肠动脉、肝动脉及直肠上、下动脉出血或可疑出血直接栓塞。结果:24例阳性中第2次血管造影显示炎症9例,小肠憩室3例,血管畸形2例,多发假性动脉瘤2例和肿瘤2例;第3次血管造影显示炎症2例,肿瘤3例和毛细血管扩张症1例。再次造影阳性和阴性出血控制率分别为79%(19/24)和53%(10/19),其中17例阳性1次灌注收缩剂或栓塞后止血,2例2次栓塞止血,4例小肠和1例结肠止血失败行手术止血;19例阴性患者采用灌注收缩剂后止血10例,7例失败行外科止血,2例死亡。所有介入治疗患者未出现严重并发症。结论:首次血管造影阴性再出血的患者再次行血管造影和介入治疗不仅能提高血管造影的阳性率,而且也能有效控制出血。

Value of Repeated Angiography and Intervention on the Digestive Tract Hemorrhage After Negative Angiography

Objective: To discuss the efficacy of repeated angiography and interventional therapy on the digestive tract hemorrhage after the first negative angiography.Methods: Repeated angiography and interventional therapy were performed in 43 cases with digestive tract hemorrhage after angiography and intervention after 1-6 hours,which included infusion of vasopressin in small intestine and colon and embolization in gastroduodenal artery,liver artery,superior rectal artery and inferior rectal artery.Results: A total of 24 patients were positive in angiogram,among them nine cases of hemorrhage caused by inflammation,three by intestinal diverticulum,two by false aneurysm and two by tumor in the second angiogram;three cases of hemorrhage were caused by inflammation,three by tumor and one by arterial venous malformation in the third angiogram.The control rate of hemorrhage with positive and negative angiographic result were 79%(19/24) and 53%(10/19) respectively.Among them 17 positive cases stopped bleeding by infusion of vasopressin and embolization once,two by repeated embolization,four by operation.Ten of 19 negative cases stopped bleeding by infusion of vasopressin,seven by operation,and two cases were dead.No serious complications occurred.Conclusion: It can increase positive rate of angiography and control bleeding by repeated angiography and interventional therapy in the digestive tract hemorrhage after the first negative angiography.