Grace D M, Gold R E
Can J Surg. 1978 Mar;21(2):171-4.
Angiography is useful in the diagnosis of active gastrointestinal bleeding if the rate is greater than 0.5 mL/min. For upper gastrointestinal bleeding, endoscopy is the preferred initial investigation and angiography is used for diagnosis only if the site of bleeding is still obscure. Angiography is the preferred method for investigation of massive lower gastrointestinal bleeding if results of sigmoidoscopy are negative. Vasopressin infusion is most useful for control of bleeding from esophageal varices, erosive gastritis and diverticular disease of the colon. Embolization with Gelfoam or clot is possible for massive hemorrhage from a single source in poor-risk patients. This is most successful for gastric or duodenal bleeding since the collateral blood supply prevents infarction. Some of the methods and complications of embolization are discussed and examples are given. Standard surgical principles should still apply in most cases.
如果胃肠道出血速度大于0.5毫升/分钟，血管造影术对诊断活动性胃肠道出血很有用。对于上消化道出血，内镜检查是首选的初始检查方法，只有在出血部位仍不清楚时才使用血管造影术进行诊断。如果乙状结肠镜检查结果为阴性，血管造影术是检查大量下消化道出血的首选方法。血管加压素输注对控制食管静脉曲张、糜烂性胃炎和结肠憩室病出血最为有效。对于高危患者单一来源的大量出血，可用明胶海绵或血凝块进行栓塞。这对胃或十二指肠出血最为成功，因为侧支血供可防止梗死。文中讨论了栓塞的一些方法和并发症并给出了示例。在大多数情况下，仍应适用标准的外科原则。
