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中华介入放射学电子杂志 ›› 2014, Vol. 02 ›› Issue (02) : 37 -39. doi: 10.3877/cma.j.issn.2095-5782.2014.02.0010

所属专题: 文献

血管介入

急诊介入治疗在急危重上消化道出血中的临床应用
钟武1, 曹传武2, 陆晨晖2, 李绍兰1, 陈睦虎1, 余平贵1, 陈红生1, 李茂全2,()   
  1. 1. 646000 泸州医学院附属医院急诊科
    2. 同济大学附属上海第十人民医院介入科
  • 收稿日期:2014-01-20 出版日期:2014-05-01
  • 通信作者: 李茂全

Clinical application of emergency interventional therapy for acute massive upper gastrointestinal hemorrhage

Wu Zhong1, Chuanwu Cao2, Chenhui Lu2, Shaolan Li1, Muhu Chen1, Pinggui Yu1, Hongsheng Chen1, Maoquan Li2,()   

  1. 1. Department of Emergrncy, Affiliated Hospitale of Luzhou Medical College, Luzhou 646000, China
  • Received:2014-01-20 Published:2014-05-01
  • Corresponding author: Maoquan Li
  • About author:
    Corresponding author: Li Maoquan, Email:
引用本文:

钟武, 曹传武, 陆晨晖, 李绍兰, 陈睦虎, 余平贵, 陈红生, 李茂全. 急诊介入治疗在急危重上消化道出血中的临床应用[J]. 中华介入放射学电子杂志, 2014, 02(02): 37-39.

Wu Zhong, Chuanwu Cao, Chenhui Lu, Shaolan Li, Muhu Chen, Pinggui Yu, Hongsheng Chen, Maoquan Li. Clinical application of emergency interventional therapy for acute massive upper gastrointestinal hemorrhage[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2014, 02(02): 37-39.

目的

观察急诊血管造影及栓塞治疗在急性消化道大出血中的临床价值。

方法

对49例消化道大出血患者(均出现失血性休克表现)急诊行消化道动脉血管造影,明确出血部位后,用聚乙烯醇颗粒、明胶海绵或弹簧圈栓塞。

结果

49例患者全部确定出血部位,其中47例栓塞出血动脉成功止血;1例因出血量大生命体征不平稳,无法行血管栓塞治疗采用急诊手术治疗;1例因高龄且病情危重,家属放弃治疗而死亡。总有效率为95.92%(47/49),术后栓塞成功患者未出现再次出血及严重并发症,治愈出院,平均住院时间为15天,1例经手术治疗住院2个月。

结论

急诊消化道血管造影检查定位率高,出血动脉栓塞治愈率高,从生理和心理上减轻了患者痛苦,是一种安全、有效、快捷的急性消化道大出血微创治疗手段。

Objective

To observe the clinical value of emergency angiography and embolism therapy for acute massive gastrointestinal hemorrhage.

Methods

A total of 49 cases of acute massive gastrointestinal hemorrhage, who had symptoms of shock, received emergency angiography. After verifying the bleeding site, the supply arteries were embolized with polyvimnyl alcohol (PVA) particle, Gelatin Sponge particle or coils.

Results

Among the 49 patients, all cases were identified of the bleeding site, 47 cases were successfully embolized of the supply arteries, 1 case received emergency open surgery instead, 1 case neither received arterial embolization nor the emergency surgery treatment because of the critical condition, and died subsequently. The total procedure effective rate was 95.92% (47/49). The patients, who were successfully embolized, never manifested bleeding or severe complications again during the hospitalization, and were discharged with cure. The average hospitalization time was 15 days. While the patients who received emergency surgery was discharged till 2 months after the operation.

Conclusions

Emergency angiography has a high diagnostic accuracy for acute massive gastrointestinal hemorrhage. Arterial embolization is an effective and minimal invasive approach with remarkable cure rate, which can alleviate the suffering of patients not only physically but also psychologically.

图1 肝固有动脉造影 胃十二指肠动脉异常伴少量对比剂外溢
图2 对比剂随胃肠道蠕动逐渐向肠腔远端扩散
图3 肠系膜上动脉造影 回结肠动脉局部血管畸形,右结肠动脉见一小假性动脉瘤,横结肠动脉分支远端瘤样膨大。
图4 插管右结肠动脉近端,栓塞后再行造影,假性动脉瘤消失,供血主干保留
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