A Clinical Research Of DSA Diagnosis And Interventional Therapy In Gastrointestinal Hemorrhage

Objective: To analyze the DSA appearances and evaluate thediagnosis value of DSA in gastrointestinal hemorrhage, to explore someeffective methods to improve the detection rate of DSA. To evaluate thecurative effect of transcatheter infusion and embolization in treatinggastrointestinal hemorrhage. And to further explore the intervention therapeuticmeasures aimed at DSA negative cases. Datas and Methods: The clinicaldatas were collected from90patients in our hospital who suffered fromgastrointestinal hemorrhage and treated with interventional treatment fromJanuary2008to December2011were analyzed retrospectively.73malesand17females. The age is between15-79years, the average age is47.2±15.7years. All the90cases were received DSA checkup and84cases ofthem had endoscopic checks, the differences of positive rate between them wascompared; take the pathology results of the33DSA positive cases after surgeryas standard, to analyze the differences between the diagnosis of DSA indifferent bleeding areas and the pathology results after the surgery. And the33DSA negative cases were chose to have a further superselective catheterization,which was discussed that improving the detection rate of bleeding are feasible.62cases were treated with embolism hemostatic treatment, the rest28cases were treated with vasopressin infusion hemostatic treatment. And to comparethe differences between the DSA positive and negative cases、the perfusion andembolism cases、the degree of blood loss before and after the intervention. Toevaluate whether the intervention was effective or not, we take an experimentalembolism in7cases which were suspected to be upper gastrointestinalhemorrhage but the DSA checkups were negative. We take a descriptivestatistics analysis of continuous variables to compare the clinical symptoms、adverse reactions and complications between before and after the intervention48h. Results: The average age is47.2±15.7years. The age is no statisticssignificance between the DSA positive and DSA negative groups (P>0.05) withMann-Whitney U test.1. The observation of diagnosis accuracy:90cases in all,84cases were under endoscopic checked, and39of them were positive, thepositive rate is46.4%;57DSA positive cases, positive rate is63.3%, there is astatistics significance between the positive rate of the two ways(P<0.05), andthe rate of DSA positive group is higher than endoscopic group. Take thepathology result of the33DSA positive cases after an surgery as standard, therate of the DSA localization diagnosis is48.8%(26/33), there is no statisticssignificance between them(P>0.05); the rate of the DSA qualitative diagnosis is72.2%(24/33), there is no statistics significance between them(P>0.05). The33DSA negative cases were chose to have a further superselective catheterization,and the sign of hemorrhage was found in12cases, accounting for76.7%of the total positive rate(69/90), which is higher than the single DSA positive rate of63.3%(57/90).2. The observation of curative effect: the total effectivehemostatic rate is77.78%(70/90), and the effective hemostatic rate of DSAnegative cases and positive cases respectively is66.67%(22/33) and84.21%(48/57)。There is a statistics significance between them(P≤0.05), and theDSA positive group is effective than the DSA negative group; The effectivehemostatic rate of the perfusion and embolism cases respectively is57.14%(16/28) and87.10%(54/62), and there is a statistics significancebetween them(P≤0.05) that the rate of embolism group is higher than theperfusion group; There are20re-bleeding cases48h after the intervention,which are9cases reduced compared with the preoperation cases,3casesbecome worse,8cases have no significant changes. The degree of hemostatic isrelieved after the operation that has a statistics significanc（eZ=-2.425；P=0.015).The effective hemostatic rate of7case which were taken an experimentalembolism is71.4%(5/7), but there is no statistics analysis because the samplesize is small.3. The observation of adverse reactions and complications afterintervention: there is no necrosis of bowel and perforation complications. Somepatients suffered from abdominal distension, abdominal pain and (or) mildperitonitis48h after intervention,3cases of prick point hematoma;2cases ofspring rims ectopic embolization,;2cases of mild to moderate liver functiondamage after hepatic artery embolization. Conclusions:1. DSA are important valuable methods for the localization diagnosis and qualitative diagnosis.2.Superselective catheterization imaging improve the positive rate of DSAcheckup.3. It is a safe and effective step to treat gastrointestinal hemorrhagewith the transcatheter perfusion and embolism, and the degree of hemostaticand clinical symptoms were reduced after intervention.4. The gastrointestinalhemorrhage in DSA negative cases could be partially controlled withexperimental embolism.5. The curative effect of intervention is better thanconservative medical management in treating gastrointestinal hemorrhage, andthe occurrence of complications is lower than the surgical operations. So it canbe a much effective treatment as well as the medicine and operation.