SATE治疗消化道出血的临床研究

发布时间：2018-03-19 10:29

本文选题：消化道出血　切入点：超选择血管造影　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：评价消化道出血超选择性动脉造影的诊断价值及经导管栓塞治疗消化道出血的临床疗效。资料和方法：1、对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)的临床资料进行回顾性分析。77例研究对象均行超选择动脉造影,明确出血56例(上消化道出血31例、下消化道出血25例)。比较上消化道出血与下消化道出血超选择性血管造影检查的阳性检出率。2、对有手术病理结果的27例(上消化道出血12例、下消化道出血15例)消化道出血阳性患者,评价其超选择性动脉造影诊断定位及定性的价值。3、以手术病理结果为标准,对上消化道出血与下消化道出血造影诊断定位及定性的符合率进行比较。4、血管造影阳性的56例患者中有栓塞适应症的41例(上消化道出血25例、下消化道出血16例)进行经导管栓塞治疗,对上、下消化道出血止血效果进行对比,并随访其即刻止血率、再出血率及术后并发症。结果：1、77例研究对象(上消化道出血42例、下消化道出血35例),超选择动脉造影明确出血56例,检出阳性率为(72.7%、56/77),其中上消化道出血阳性结果31例(73.8%、31/42),下消化道出血阳性结果25例(71.4%、25/35)。经统计学分析,P0.05,超选择性血管造影检查下消化道出血阳性检出率不低于上消化道出血的阳性检出率。2、有手术病理结果的27例消化道出血患者,超选择血管造影定位符合率81.5%(22/27)、定性符合率为74.1%(20/27),与外科术后病理检查无统计学差异。3、通过与手术病理对照,超选择性动脉造影上消化道出血的定位符合率为83.3%(10/12)、定性符合率为75.0%(9/12)；下消化道出血定位符合率为80.0%(12/15)、定性诊断符合率为73.3%(11/15),两者造影的定位、定性符合率无统计学差异。4、对第一部分血管造影为阳性的56例患者中有栓塞适应症的41例(上消化道出血25例、下消化道出血16例)消化道出血经导管栓塞术后即刻止血34例,即刻止血率为82.9%,其中上消化道出血组为84.0%(21/25),下消化道出血组为81.3%(13/16)；经统计学分析,P0.05,得出经导管栓塞治疗下消化道出血的疗效不差于上消化道出血。复发出血3例(2例位于胃十二指肠动脉,1例位于肠系膜上动脉的分支),均为胰腺炎所致的假性动脉瘤,复发出血率为8.82%(3／34)。5、经导管栓塞止血术后的不良反应及并发症观察：消化道出血介入栓塞治疗的术后并发症,与一般的腹部疾病介入栓塞术后大致相同,常见的有腹痛、轻中度发热。本研究中未出现心律失常、肠管坏死、穿孔,异位栓塞等严重并发症。结论：1、超选择性血管造影对上、下消化道出血的定位及定性诊断价值较高,是消化道出血可靠的诊断方法。2、经导管栓塞治疗下消化道出血同上消化道出血一样安全、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.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R573.2;R816.5

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