Rösch J, Antonovic R, Dotter C T
Rofo. 1976 Oct;125(4):301-10. doi: 10.1055/s-0029-1230467.
The author's current angiographic approach to the diagnosis and therapy of acute gastrointestinal (GI) bleeding is summarized and discussed. It is based on the authors' experience with diagnostic studies in more than 300 acute GI bleeders and the use of various angiotherapeutic techniques in 138 of them as well as the experience of others. A "moderately aggressive angiographic approach" is advocated for the diagnosis of acute GI bleeding in most patients with angiography used as needed after emergency endoscopy and preliminary medical therapy. Vasoconstrictive angiotherapy with selective intraarterial use of vasopressin is partially giving way to low dose, intravenous infusion of vasopressin and, where possible, to direct vascular occlusion. Selective transcatheter embolic occlusion of bleeding vessels is in indicated cases an accepted method for controlling arterial bleeding. Medical gelatin (Gelfoam) is the current authors' embolization material of choice. Selective variceal occlusion offers promising means for management of bleeding from gastroesophageal varices. Its possible combination with transcatheter intrahepatic portosystemic shunting might also provide non-surgical relief of portal hypertension.
本文总结并讨论了作者目前用于急性胃肠道（GI）出血诊断和治疗的血管造影方法。它基于作者对300多名急性胃肠道出血患者进行诊断研究的经验，以及对其中138名患者使用各种血管治疗技术的经验，还有其他方面的经验。对于大多数急性胃肠道出血患者，提倡采用“适度积极的血管造影方法”进行诊断，即在紧急内镜检查和初步药物治疗后，根据需要进行血管造影。选择性动脉内使用血管加压素的血管收缩性血管造影疗法正部分地被低剂量静脉输注血管加压素所取代，并在可能的情况下被直接血管闭塞所取代。在有指征的病例中，选择性经导管栓塞出血血管是控制动脉出血的一种公认方法。医用明胶（明胶海绵）是作者目前首选的栓塞材料。选择性静脉曲张闭塞为治疗胃食管静脉曲张出血提供了有前景的方法。它与经导管肝内门体分流术的可能联合应用也可能为门静脉高压提供非手术缓解。
