小肠出血67例诊治分析

目的：探讨小肠出血的原因，诊断和治疗。方法：回顾性分析67例经手术及病理证实的小肠出血的临床资料。结果：小肠出血原因中肿瘤占首位（29/67），良、恶性肿瘤差异不明显，其他原因依次为炎性肠病（15/67），小肠憩室（12/67）及血管病变（7/67），分别有18、17和10例病人经小肠气钡双重造影，选择性肠素膜血管造影及核素扫描确诊，18例剖腹探查确诊，全组病人均经手术治疗，以肠段切除为主要手术方法。结论：小肠出血原因肿瘤占首位，其次分别为炎性肠病，小肠憩室及血管病变，小肠气钡双重造影，选择性肠系膜血管造影及核素扫描为诊断小肠出血的主要手段，剖腹探查对常规检查难以确诊且又高度怀疑小肠出血的病人也是一种主要诊断手段。小肠出血治疗以药物，内镜治疗为首选，如效果不佳则行手术治疗，主要为包括病变在内的肠段切除。     

小肠出血的诊断及外科治疗体会（附37例报告）

目的探讨小肠出血的原因、诊断和治疗。方法回顾性分析37例经手术及病理证实的小肠出血的临床资料。结果小肠出血原因中肿瘤占首位（14／37），良、恶性肿瘤差异不明显，其他原因依次为炎性肠病（7／37）、小肠憩室（6／37）及血管病变（3／37）。全组患者均经手术治疗，以肠段切除为主要手术方法。结论小肠出血原因肿瘤占首位，其次分别为炎性肠病、小肠憩室及血管病变。小肠气钡双重造影、选择性肠系膜血管造影及核素扫描为诊断小肠出血的主要手段．剖腹探查对常规检查难以确诊且又高度怀疑小肠出血的患者也是一种主要诊断手段。小肠出血治疗以药物、内镜治疗为首选，如效果不佳则行手术治疗，主要为包括病变在内的肠段切除。     

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目的 探讨小肠出血的原因、诊断和治疗方法。方法 回顾性分析1988～1998年经手术及病理证实的小肠出血67例的临床资料。结果 小肠出血原因中肿瘤占首位(29例)，良、恶性肿瘤差异不明显，其他原因依次为炎性肠病(15例)、小肠憩室(12例)、血管病变(7例)及家族性肠息肉病(4例)。67例病人均经手术治疗，以肠段切除为主要手术方法。结论 小肠气钡双重造影、选择性肠系膜血管造影及核素扫描为诊断小肠出血的主要手段，对常规检查难以确诊且又高度怀疑小肠出血的病人可采用剖腹探查。     

小肠出血38例诊治体会

目的探讨小肠出血的原因、诊断和治疗方法。方法回顾分析1998年2月至2010年1月收治的经手术及病理证实的小肠出血38例临床资料。结果 38例小肠出血原因中肿瘤占首位,为18例(47.4%),良性、恶性肿瘤差异不明显,其他原因依次为炎性肠病9例(23.7%)、小肠憩室7例(18.4%)、血管病变3例及钩虫病1例。全组病人均经手术治疗,其中32例(84.2%)行病变段肠管切除术。结论诊断小肠出血的主要手段包括小肠气钡双重造影、选择性肠系膜血管造影、核素扫描等,对原因不明的出血行剖腹探查及术中纤维内镜分段检查。主要有效治疗方法为切除病变段肠管。     

小肠出血45例分析

目的:探讨小肠出血的病因、诊断和治疗方法.方法:回顾性分析1998～2005年经手术及病理证实的小肠出血45例的临床资料.结果:小肠出血原因中血管畸形(19例)占首位,其次为炎性肠病(13例)、小肠憩室(10例)及家族性肠息肉病(3例).45例均经手术治疗.结论:诊断小肠出血的主要手段包括小肠气钡双重造影、选择性肠系膜血管造影及核素扫描.对原因不明的反复出血应行诊断性剖腹探查.     

49例小肠出血的临床分析

目的 探讨小肠出血的诊断方法，方法 回顾性分析49例小肠出血的临床资料。结果 肿瘤21例（42.9%)，以良性肿瘤多见；感染性疾病12例（24.5%)；憩室8例（16.3%)；血管畸形6例（12.2%)，各种检查的阳性率，核素扫描76.9%，血管造影58.9%，肠系X线25%，术后再出血5例，短肠综合征1例。结论 小肠出血以肿瘤最常见，感染性疾病值得重视。核素扫描憩室的阳性率高，选择性血管造影对血管病变及富含血管的病变有较高的诊断价值，肠系X线对实质性病变及憩室的诊断率较高，剖腹探查结合术中内镜可以提高诊断率。     

下消化道出血118例诊治分析

目的分析下消化道出血病因,总结诊治经验。方法对1999年1月至2009年12月诊治的118例下消化道出血的临床资料进行回顾性分析。结果下消化道出血发生原因依次为肿瘤(69.5%)、血管畸形(13.6%)、炎症性肠病(5.9%)、肠憩室(5.9%),均经手术或病理证实。结论肿瘤及血管畸形是引起下消化道出血的主要原因。增强螺旋CT扫描、内镜、选择性肠系膜血管造影、核素扫描是下消化道出血的主要诊断方法。     

小肠疾病致消化道出血46例诊治及回顾

小肠疾病致消化道出血是指在Treitz韧带至回盲部之间小肠疾病所致的消化道出血,较为少见,其主要的病因包括小肠良恶性肿瘤、克罗恩病、肠道血管畸形、感染及小肠憩室、炎性肠病、缺麻性肠病及门脉高压性肠病等,但因常用的诊断技术无法达到该部．且该病缺乏特异性临床规律,故术前明确出血部位和决定手术比较困难。就我院2008年1月-2010年12月诊治的小肠出血性疾病作一回顾总结。     

下消化道出血11例诊治体会

目的探讨不明原因下消化道出血的手术诊治体会。方法回顾性分析10年间经内镜、血管造影、增强CT扫描及核素扫描均不能明确下消化道出血部位及原因、由于反复出血或出血凶猛而采用剖腹探查诊治者11例的临床资料。结果最常见的出血原因是血管发育不良或畸形(5例),其次,小肠憩室2例,小肠平滑肌瘤1例,3例原因不明。最终的手术方式主要是右半结肠切除(7例),其他有病变小肠段切除3例及结肠次全切除1例。死亡率27.3%,再出血率18.2%。结论原因不明的下消化道出血,多数病人可以通过剖腹探查明确诊断及治疗,应及时手术。     

小肠出血的诊断和治疗(附76例报告)

目的探讨小肠出血的病因、诊断和治疗措施。方法对我院近8年收治的病因明确的76例小肠出血病人的临床资料进行回顾性分析。结果本组小肠出血病人肿瘤占首位(37/76),其中包括小肠间质瘤32例,其余依次为美克尔憩室(21/76)、血管病变(15/76)及异位胰腺(3/76)。经数字减影血管造影诊断21例,小肠气钡双重对比造影诊断13例,腹腔核素扫描诊断11例,小肠镜检查诊断6例,腹腔镜探查诊断21例,剖腹探查诊断4例。全组病人均经手术治疗,手术方式以包括病变在内的小肠部分切除术为主(68/76)。随访时间6月～5年,临床疗效满意。结论气钡双重对比造影、核素扫描、数字减影血管造影、腹腔镜探查及剖腹探查是诊断小肠出血的主要手段。包括病变在内的小肠部分切除术是治疗小肠出血最有效方法。     

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??Diagnosis and analysis of causes of small intestinal bleeding WANG Ting, WANG Ling LING Rui, et al. Department of Vascular Surgery, XI JING Hospital, the Fourth Military Medical University, Xi’an 710032, China Corresponding author??WANG Ting, E-mail??ting_w100@126.com Abstract Objective To summarize the diagnosis and treatment experiences and causes of small intestinal bleeding. Methods The clinical data of 74 cases of small intestinal bleeding admitted between 1990 and 2004 in the No 3 Department of General Surgery, XI JING Hospital of the Fourth Military Medical University were analyzed retrospectively. The causes of bleeding in all the cases were confirmed by surgery and pathology. Results The main cause of small intestinal hemorrhage was tumor (41.9%), while the other causes in turn were small intestinal diverticulum (25.7%), vasculopathy (23.0%), and inflammatory small intestinal diseases (9.5%). But to young cases (≤45), the main causes of small intestinal hemorrhage were small intestinal diverticulum (42.1%) and tumor (28.9%), while they were tumor (55.6%) and vasculopathy (27.8%) to aged cases (??45). All the cases were treated by operation. Conclusion Tumor is the most common cause of small intestinal bleeding. Other causes are small intestinal diverticulum, inflammatory small intestinal diseases and angiodysplasia. The double-contrast barium meal, angiography and radionucleide scanning were the main diagnostic methods for small intestinal bleeding. Abdominal laparotomy was also a diagnostic method if the results of auxiliary examinations were negative.     

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??Adult lower gastrointestinal hemorrhage caused by Meckel’s diverticulum??A clinical analysis of 37 cases QU Feng-zhi??CAO Cheng-liang??WANG Gang??et al. Department of Hepatobiliary and Pancreatic Surgery??the First Affiliated Hospital??Harbin Medical University??Harbin 150001??China
Corresponding author??WANG Gang, E-mail??wgilu79@163.com
Abstract Objective To summarize and analyze the clinical characteristics??diagnosis and treatment principle of adult lower gastrointestinal bleeding caused by Meckel’s diverticulum. Methods The clinical data of 37 cases of adult lower gastrointestinal hemorrhage caused by Meckel’s diverticulum admitted from January 2007 to January 2016 in the First Affiliated Hospital of Harbin Medical University were analyzed retrospectively. Single diverticulum resection was performed in four cases, and diverticulum resection combined with partial small intestine resection and anastomosis was performed in thirty-three cases. Results The lower gastrointestinal bleeding of all the patients who performed surgical treatment had been salved effectively. Postoperative hospital stay was 11.6 (8 to 15) day??without death and serious complication??and all the cases were recovered. All the cases were diagnosed Meckel’s diverticulum by pathological examination postoperatively. Eight cases lost the follow up, and 29 cases were followed up for 4 to 111 months with good general condition??had not been bleeding again. Conclusion Meckel’s diverticulum is a rare cause of adult lower gastrointestinal bleeding. Clinical manifestations and preoperative diagnosis methods of Meckel’s diverticulum are lack of specificity??and therefore it leads to misdiagnosis and missed diagnosis easily. Surgery is the only effective way to its diagnosis and treatment.     

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??Diagnosis and treatment of gastrointestinal hemorrhage resulted from small intestinal diseases WANG Qiang, KOU You-wei. Department of Gastrointestinal and Nutrition Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
Corresponding author: WANG Qiang, E-mail: wangq@sj-hospital.org
Abstract Small intestinal disease is the rare cause of gastrointestinal hemorrhage. Diagnosis and treatment is very difficult. The main causes of bleeding include tumor, small intestinal vessels disease and inflammatory disease. The diagnosis of these diseases are mainly according to capsule endoscopy, enteroscopy, DSA and radioisotope scanning. Explorative operation is the last choice because of low definited diagnosis rate and high risk. Treatment first is to keep the vital sign stable. The second is to identify the cause. All the treatment including further expectant treatment and operation must be according to the diagnosis.     

小肠出血病因临床诊断及治疗

目的总结小肠出血的病因、临床表现、诊断及治疗经验。方法回顾性分析1995年1月～2009年9月北京大学第三医院普外科收治的35例小肠出血患者的病因、临床表现、诊断及治疗。结果除出血表现外,62.9%(22/35)不伴其他症状,85.7%(30/35)不伴腹部阳性体征。35例均伴有贫血,其中急性大出血4例,慢性显性出血29例,慢性隐性出血2例。入院时血红蛋白中位数67g/L(30～108g/L)。入院时合并失血性休克4例(11.4%)。小肠肿瘤占37.1%(13/35),其次为小肠憩室31.4%(11/35),小肠炎症22.9%(8/35),血管疾病8.6%(3/35)。2例行内镜下止血治疗;33例外科手术治疗(28例行小肠部分切除肠吻合术,5例行腹腔镜下憩室局部切除),其中开腹手术19例,腹腔镜手术14例。术中肠镜7例。结论小肠出血的症状与体征无特异性,小肠肿瘤、小肠憩室、小肠炎症是小肠出血常见原因。术中肠镜检查为最后诊断隐匿性小肠出血的有效方法。外科手术治疗是治疗小肠出血最有效的方法 。     

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??Application of small bowel enteroscopy in the diagnosis and therapy of obscure gastrointestinal bleeding WANG Xin. Xijing Hospital of Digestive Diseases, the Forth Military Medical University, Xi’an 710032, China
Abstrct Obscure gastrointestinal bleeding contributes to 3%-5% of gastrointestinal bleeding cases and mainly locates in the small bowel. It is hard to explore small intestinal by conventional techniques including upper endoscopy and colonoscopy, and is difficult to identify the precise bleeding sites. The development of double or single balloon enteroscopy brings hope to improve the diagnostic yield with some cases of bleeding being endoscopic intervened directly.     

数字减影血管造影与介入治疗在胃肠道动脉性出血中的应用价值

目的 探讨数字减影血管造影(DSA)诊断与介入治疗在胃肠道动脉性出血中的应用价值.方法 回顾性总结78例消化道动脉性出血患者的DSA表现和动脉栓塞、药物灌注的治疗经验.结果 本组患者十二指肠溃疡15例,胃溃疡5例,胃癌2例,Dieulafoy病1例,血管畸形和发育不良9例,胃肠术后吻合口出血8例,肝胆疾患术后肝动脉破裂出血10例,Crohn病5例、肠道憩室出血6例、小肠炎或溃疡6例,小肠息肉3例,小肠中度恶性间质瘤1例,小肠高分化平滑肌肉瘤2例,直结肠癌5例.74%(58/78)的患者DSA造影阳性,造影剂外溢直接征象者33%(26/78),术后吻合口出血直接征象者83%(15/18).介入治疗的病例中动脉药物灌注15例,技术成功率60%(9/15),临床成功率40%(6/15);栓塞36例,技术成功率86%(31/36),临床成功率72%(26/36);介人治疗后再出血率16%(8/51),其中1例栓塞后再呕血经胃镜治疗无效死亡.DSA造影和介入治疗后手术者27例,造影与术后病理诊断的符合率为78%(21/27).随访时间2个月至3年,未发生胃肠道缺血坏死等并发症.结论 DSA对消化道动脉性出血的定位、定性有着重要价值,选择性动脉栓塞及药物灌注止血安全有效,有助于择期手术和并发症处理.