本文選題：消化道出血　切入點：超選擇血管造影　出處：《山西醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：評價消化道出血超選擇性動脈造影的診斷價值及經(jīng)導管栓塞治療消化道出血的臨床療效。 資料和方法：1、對77例消化道出血患者(上消化道出血42例、下消化道出血35例)的臨床資料進行回顧性分析。77例研究對象均行超選擇動脈造影,明確出血56例(上消化道出血31例、下消化道出血25例)。比較上消化道出血與下消化道出血超選擇性血管造影檢查的陽性檢出率。2、對有手術病理結果的27例(上消化道出血12例、下消化道出血15例)消化道出血陽性患者,評價其超選擇性動脈造影診斷定位及定性的價值。3、以手術病理結果為標準,對上消化道出血與下消化道出血造影診斷定位及定性的符合率進行比較。4、血管造影陽性的56例患者中有栓塞適應癥的41例(上消化道出血25例、下消化道出血16例)進行經(jīng)導管栓塞治療,對上、下消化道出血止血效果進行對比,并隨訪其即刻止血率、再出血率及術后并發(fā)癥。 結果：1、77例研究對象(上消化道出血42例、下消化道出血35例),超選擇動脈造影明確出血56例,檢出陽性率為(72.7%、56/77),其中上消化道出血陽性結果31例(73.8%、31/42),下消化道出血陽性結果25例(71.4%、25/35)。經(jīng)統(tǒng)計學分析,P0.05,超選擇性血管造影檢查下消化道出血陽性檢出率不低于上消化道出血的陽性檢出率。2、有手術病理結果的27例消化道出血患者,超選擇血管造影定位符合率81.5%(22/27)、定性符合率為74.1%(20/27),與外科術后病理檢查無統(tǒng)計學差異。3、通過與手術病理對照,超選擇性動脈造影上消化道出血的定位符合率為83.3%(10/12)、定性符合率為75.0%(9/12)；下消化道出血定位符合率為80.0%(12/15)、定性診斷符合率為73.3%(11/15),兩者造影的定位、定性符合率無統(tǒng)計學差異。4、對第一部分血管造影為陽性的56例患者中有栓塞適應癥的41例(上消化道出血25例、下消化道出血16例)消化道出血經(jīng)導管栓塞術后即刻止血34例,即刻止血率為82.9%,其中上消化道出血組為84.0%(21/25),下消化道出血組為81.3%(13/16)；經(jīng)統(tǒng)計學分析,P0.05,得出經(jīng)導管栓塞治療下消化道出血的療效不差于上消化道出血。復發(fā)出血3例(2例位于胃十二指腸動脈,1例位于腸系膜上動脈的分支),均為胰腺炎所致的假性動脈瘤,復發(fā)出血率為8.82%(3／34)。5、經(jīng)導管栓塞止血術后的不良反應及并發(fā)癥觀察：消化道出血介入栓塞治療的術后并發(fā)癥,與一般的腹部疾病介入栓塞術后大致相同,常見的有腹痛、輕中度發(fā)熱。本研究中未出現(xiàn)心律失常、腸管壞死、穿孔,異位栓塞等嚴重并發(fā)癥。 結論：1、超選擇性血管造影對上、下消化道出血的定位及定性診斷價值較高,是消化道出血可靠的診斷方法。2、經(jīng)導管栓塞治療下消化道出血同上消化道出血一樣安全、可行。
[Abstract]:Objective: to evaluate the diagnostic value of superselective arteriography and the clinical effect of transcatheter embolization for gastrointestinal hemorrhage. Materials and methods the clinical data of 77 cases of gastrointestinal hemorrhage (upper gastrointestinal hemorrhage 42 cases, lower gastrointestinal hemorrhage 35 cases) were retrospectively analyzed. 77 cases were studied by superselective arteriography. There were 56 cases of hemorrhage (31 cases of upper gastrointestinal bleeding). The positive rate of superselective angiography was compared between upper gastrointestinal hemorrhage and lower gastrointestinal hemorrhage in 25 cases, and 27 cases with surgical and pathological results (12 cases of upper gastrointestinal hemorrhage, 12 cases of upper gastrointestinal hemorrhage) were compared. In 15 cases of lower gastrointestinal hemorrhage, the value of superselective arteriography in the diagnosis, localization and qualitative analysis of gastrointestinal bleeding was evaluated, and the results of operation and pathology were taken as the standard. The diagnostic and qualitative coincidence rates of upper gastrointestinal hemorrhage and lower gastrointestinal hemorrhage were compared. 4. Among 56 patients with positive angiography, 41 had embolization indication (25 with upper gastrointestinal hemorrhage). The hemostatic effect of upper and lower gastrointestinal bleeding was compared, and the immediate hemostatic rate, rebleeding rate and postoperative complications were followed up. Results Seventy-seven cases (42 cases of upper gastrointestinal hemorrhage, 35 cases of lower digestive tract hemorrhage, 56 cases of hyperselective arteriography) were studied. The positive rate was 72.7% 56 / 77, among which 31 cases of upper gastrointestinal hemorrhage were positive, 31 cases were 73.83.82%, 25 cases of lower digestive tract hemorrhage were 71.4% / 35%. By statistical analysis, the positive rate of upper gastrointestinal tract hemorrhage was not lower than that of upper digestive tract hemorrhage by superselective angiography (P 0.05), and the positive rate of upper digestive tract hemorrhage was not lower than that of upper alimentary tract hemorrhage by superselective angiography. The positive rate of bleeding was. 2. 27 cases of gastrointestinal bleeding with surgical and pathological results. The coincidence rate of superselective angiography was 81.5% and 22 / 27%, and the qualitative coincidence rate was 74.1% and 20 / 27% respectively. There was no significant difference between the two groups in terms of pathological examination after surgery. The coincidence rate of upper gastrointestinal hemorrhage by superselective arteriography was 83.310 / 12, the qualitative coincidence rate was 75.0 / 12, and that of lower digestive tract hemorrhage was 80.0 / 12 / 15, and the accuracy of qualitative diagnosis was 73.3 / 11 / 15 / 15, respectively. There was no significant difference in the qualitative coincidence rate. Among the 56 patients who were positive for the first part of angiography, 41 cases (25 cases of upper gastrointestinal bleeding, 16 cases of lower gastrointestinal bleeding) were treated with endovascular embolization. 34 cases of gastrointestinal bleeding were hemostatic immediately after transcatheter embolization. The immediate hemostasis rate was 82.9, including 84.021 / 25 in upper gastrointestinal hemorrhage group and 81.33 / 13 / 16 in lower digestive tract hemorrhage group. By statistical analysis of P0.05, it was concluded that transcatheter embolization treatment of lower gastrointestinal bleeding was no worse than that of upper digestive tract hemorrhage. One case located in the superior mesenteric artery located in the gastroduodenal artery was pseudoaneurysm caused by pancreatitis. The rate of recurrent bleeding was 8.82 / 3 / 34 / 5. The adverse reactions and complications after transcatheter embolization and hemostasis: the complications of interventional embolization of gastrointestinal bleeding were approximately the same as those of common abdominal diseases after interventional embolization, with common abdominal pain. Mild to moderate fever. There were no serious complications such as arrhythmia, intestinal necrosis, perforation and ectopic embolism. Conclusion: superselective angiography is a reliable diagnostic method for upper and lower gastrointestinal bleeding, and is a reliable diagnostic method for upper and lower gastrointestinal bleeding. It is safe and feasible to treat lower gastrointestinal hemorrhage with catheter embolization as with upper gastrointestinal hemorrhage.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R573.2;R816.5

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