Popiela Tadeusz J, Brzegowy Paweł, Kibil Wojciech
Katedra Radiologii, Uniwersytet Jagielloński, Collegium Medicum.
Przegl Lek. 2013;70(5):303-7.
Colonoscopy remains a method of choice in the management of acute bleeding from the lower gastrointestinal tract. However, the efficiency of the method to locate the source of bleeding and control is significantly lower, when the patient cannot be prepared for the procedure. When the source of bleeding is not possible to locate by endoscopy, the patient usually undergoes major surgery with high risk of complications or even death. The study analyzed the effectiveness of angiography with embolisation of arterial vessels supplying lower gastrointestinal tract as the alternative for surgical operation in cases when endoscopic procedures are ineffective in locating the source of bleeding. The analysis was conducted in 27 patients fulfilling the above criteria. All patients underwent diagnostic angiography which localized the source of bleeding in 19/27 (70%) of them. Embolisation procedures performed in 11/27 (41%) patient, while successful control of bleeding was achieved in 9/11 (89%) of them. No complications were found in the analyzed group related to the performed intravascular procedures. Positive effect of angiography, when embolisation is not possible to perform, may be the indication for targeted therapeutic endoscopy or selective surgical resection of the intestinal segment. The embolisation is safe and effective method of controlling acute lower gastrointestinal tract bleeding with low risk of ischemic complications.
结肠镜检查仍然是处理下消化道急性出血的首选方法。然而，当患者无法为该检查做好准备时，该方法定位出血源并进行控制的效率会显著降低。当无法通过内镜检查定位出血源时，患者通常要接受有高并发症风险甚至死亡风险的大手术。本研究分析了对供应下消化道的动脉血管进行栓塞的血管造影术作为内镜检查无法有效定位出血源时手术替代方案的有效性。对符合上述标准的27例患者进行了分析。所有患者均接受了诊断性血管造影，其中19/27（70%）的患者出血源得以定位。11/27（41%）的患者进行了栓塞手术，其中9/11（89%）的患者成功控制了出血。在分析的组中未发现与所进行的血管内操作相关的并发症。当无法进行栓塞时，血管造影的积极作用可能是进行靶向治疗性内镜检查或选择性肠段手术切除的指征。栓塞是控制急性下消化道出血的安全有效方法，缺血性并发症风险低。
