The Clinical Study Of Arterial DSA Diagnosis And Embolotherapy In Gastrointestinal Hemorrhage

PARTⅠ: Arterial DSA Diagnosis of Gastrointestinal Hemorrhage Objective: To evaluate the diagnostic value of digital subtraction angiography(DSA) findings in gastrointestinal hemorrhage, and investigate how to improve the detection rate of DSA.Materials and Methods : 1.DSA findings of 135 patients with gastrointestinal hemorrhage were analyzed retrospectively.2. 32 positive patients of those underwent operation,comparative studies with pathology were done to evaluate the accuracy of DSA detection.3.29 negative cases were performed superselective catheterization,to investigate the effect of raising the DSA detection of gastrointestinal hemorrhage. and the positive rate of DSA was calculated.Results:1.Positive rate of DSA was 58.5%(79/135),the findings were contrast material efflux or intra-intestinal collection (n=46),abnormal vascular (n=33).2.Compared to pathology ,accuracy rate of DSA location detection was 84.4﹪, qualitation diagnostic rate was 78.1%.3. 7 cases with negative DSA findings and 5 cases with doubtful hemorrhagic findings were detected definitely by superselective angiography,the detection rate was 41.4%. Conclusion:1. DSA is a dependable method to detect gastrointestinal hemorrhage.2. Superselective catheterization is able to improve the DSA detection of gastrointestinal hemorrhage.PARTⅡ: Arterial Interventional Embolotherapy of Gastrointestinal HemorrhageObjective: To evaluate the value of Interventional embolotherapy of gastrointestinal hemorrhage, and the correlated influential factors as well; to investigate the interventional management in DSA negative cases.Materials and Methods:1.39 cases with indication underwent interventional embolotherapy in 79 positive patients, immediate hemostasis rate and re-hemorrhage rate were checked up after embolization ,and complications were observed,then evaluated the therapeutic effect and safety.2.In 56 negative patients , 16 cases treated with trial embolotherapy in upper gastrointestinal and 5 cases treated with vasopressin infusion in lower gastrointestinal.Results: 1. Immediate hemostasis rate was 87.2%(34/39) in embolotherapy of gastrointestinal hemorrhage, all of the 3 re-hemorrhage patients were severe acute pancreatitis ,re-hemorrhage rate was 8.8%(3/34).2. Immediate hemostasis rate was 68.8% and re- hemorrhage rate was 18.2% in group trial embolotherapy ; 3 in 5 patients treated with vasopression infusion were effective , and all of the 3 patients recurrent.Conclusion:1. Interventional embolotherapy is a safe and effective method to manage gastrointestinal hemorrhage.2. Trial embolotherapy can control the upper gastrointestinal hemorrhage and vasopressin infusion can control the lower gastrointestinal hemorrhage in some DSA negative cases ,but re-hemorrhage rate is higher in the latter.