腹部外科术后急性消化道大出血的血管造影诊断与介入治疗

摘要

Objective To evaluate the clinical value of angiography and intcrvcntional therapy for acute massive alimentary tract hemorrhage after abdominal surgical procedure. Methods Twenty patients underwent angiography because of gastrointestinal or in-tra-abdominal bleeding after abdominal surgery. Urgent angiography and/or transartcrial cmbolization was performed in all 20 patients. The clinical and angiographic features were retrospectively reviewed. Results Angiography revealed a discrete bleeding focus in 18 (90%) of 20 patients. DSA features including contrast medium accumulation at the gastrointestinal tracts outside the vessels in 9 cases, pscudoancurysm in 6 cases, fusiform ancurysm in 3 cases. Transartcrial cmbolization was technically successful in 13 (72%) of 18 patients with a discrete bleeding focus. There were no rcblccding and intestinal ischacmia or necrosis were observed 1 month after operation. Conclusion There is a high detecting rate for bleeding site with angiography in patients with iatrogenic gastrointestinal hemorrhage. Transartcrial cmbolization is considered to be an effective and safe mean in the management of iatrogenic gastrointestinal hemorrhage.%目的 探讨血管造影诊断与介入治疗在腹部外科手术后发生的急性消化道大出血治疗中的临床价值.方法 20例患者因腹部外科手术后急性消化道大出血而行选择性血管造影,回顾性分析其血管造影结果及栓塞治疗价值.结果 20例腹部外科手术后大出血患者中血管造影阳性发现有18例(90%),主要表现为造影剂外溢9例、假性动脉瘤6例、梭形动脉瘤3例.18例造影阳性患者中,13例(72%)成功地进行了动脉内栓塞治疗,控制了消化道大出血,随访1个月,无出血复发,无肠缺血坏死等严重并发症.结论 血管造影诊断检查在医源性消化道出血患者中诊断阳性率高,同时经动脉内栓塞治疗腹部外科手术后大出血是一种有效、安全的治疗方法.