急性下消化道出血并失血性休克的诊治

目的 探讨急性下消化道出血并失血性休克的诊治措施。方法 回顾性分析应用剖腹探查术结合术中肠镜检查对12例急性下消化道出血并失血性休克患者诊治的临床资料。结果 除1例患者死于DIC外，余患者明确了诊断、抢救成功。结论 对急性下消化道大出血的患者，支持治疗无效的情况下应积极手术，术中肠镜有助于明确诊断，急诊手术是处理出血最有效的方法。     

结肠血管扩张症合并下消化道出血的诊治分析

目的：探讨合并下消化道出血结肠血管扩张症的诊断与外科治疗。方法：回顾性分析1998年9月至2001年3月住院诊治的6例结肠血管扩张症合并下消化道出血的临床资料。结果：5例年龄＞60岁;4例为急性大出血,2例为间歇性显性出血;5例纤维结肠镜均无阳性发现,3例行99mTc-细胞显像均见异常放射性聚集,5例行选择性内脏血管造影均显示病变结肠肠壁血管“静脉相”迂曲,扩张;4例急性大出血者作病变结肠肠段切除,痊愈出院。结论：（1）凡老年人无诱因出现下消化道出血者应想到结肠血管扩张症的可能性;（2)99mTc-红细胞显像是消化道出血定位诊断的筛选方法,选择性肠系膜动脉造影是结肠血管扩张症定性诊断的首选;（3）手术切除病变肠段是其可靠的治疗手段。     

结肠血管发育不良合并下消化道出血的临床研究

目的:探讨结肠血管发育不良合并下消化道出血的诊断与外科治疗。方法:回顾性分析13例结肠血管发育不良的合并消化道出血的临床。结果:9例年龄>60岁,8例为急性大出血,5例为间歇性出血;10例纤维结肠镜均无阳性发现,4例99锝红细胞显像均见有异常放射性聚集,8例行选择性肠系膜血管造影均显示病变结肠肠壁血管“静脉相”迂曲、扩张;8例急性大出血作病变结肠肠段切除,痊愈出院。结论:中老年人无明原因出现下消化道出血者需考虑到结肠血管发育不良的可能性。选择性肠系膜动脉造影是首选;用99锝红细胞显像是下消化道出血定位诊断的筛选方法,最终手术切除是可靠的治疗手段。     

急诊结肠镜检查对急性下消化道出血诊治的价值

目的探讨急诊结肠镜检查在急性下消化道出血中的诊断和治疗价值。方法回顾性分析因急性下消化道出血而行急诊结肠镜检查的38例患者的内镜诊断与治疗资料。结果 38例急性下消化道出血均查明了出血病因,并于镜下成功止血;其中11例息肉出血,2例血管畸形破裂出血均在急诊结肠镜治疗后痊愈,治愈率100.0%。结论急诊结肠镜检查可查明急性下消化道出血的病因;对息肉性出血和血管畸形破裂出血进行病因性治愈;对其他出血性疾病起到临时止血,为进一步治疗提供临床依据。急诊结肠镜检查在急性下消化道出血的诊治中安全有效。     

升结肠良性息肉并失血性休克1例诊治体会

消化道出血是临床常见症状。根据出血部位分为上消化道出血和下消化道出血。临床上根据失血量与速度将消化道出血分为慢性隐性出血、慢性显性出血和急性出血。急性大量出血死亡率约占10％，60岁以上患者出血死亡率高于中青年人，约占30％～50％。但良性结肠息肉引起的急性大失血临床少见，诊治上有其特殊性。本科收治1例．取得较好疗效，现报告如下。     

肠血管疾患所致的下消化道大出血

下消化道出血通常有两类,即非大量(又称活动性出血)和急性大量出血。前者指由于下消化道疾患所引起的肉眼可见血便,包括鲜血便(可有或无血块)、果酱样和暗红色稀便,但尚未引起血液动力学改变,后者则是短时间内大量便血,导致休克且需输血治疗的病例。大出血病国外报告以结肠憩室、肠血管畸形占半数以上。国内憩室病很少见,而肠血管疾患,如肠道血管畸形、肠系膜血管闭塞等引起的急性下消化道大出血,临床上并不少见。     

SPECT/CT和术中内镜联合应用在不明原因下消化道出血中的定位诊断作用

目的 评价SPECT／CT和术中内镜联合应用在不明原因下消化道出血中的定位诊断作用。方法 分析26例不明原因急性下消化道出血住院患者的诊治情况。结果 本组26例患者均能术中发现病灶及病因，其中SPECT／CT检查阳性率为88．5％，术中纤维内镜定位准确率为100％，随访1个月至2年无复发。结论 不明原因急性下消化道出血患者首选SPECT／CT检查，确定大致部位后，术中再行纤维内镜确切定位，行确定性手术治疗，效果满意。     

急性下消化道大出血的检查与治疗

目的 探讨急性下消化道大出血的诊治方法。方法 分析２１例急性下消化道大出血的诊治经过。结果 本组２１例中６例药物治疗止血成功,成功率２８．６％。肠系膜动脉造影阳性率９２．８％,介入治疗成功率８４．６％,随访１个月至４年无复发。结论 急性下消化道大出血首先选用药物治疗。出血不能控制者宜选用选择性肠系膜动脉造影检查。造影确认出血动脉后同时介入栓塞治疗。造影阴性而出血不能控制者应手术探查。     

165例下消化道出血的临床诊断

下消化道是包括从Trcitz韧带以下至肛门的一段肠管，下消化道出血是指Treitz韧带以下的空肠、回肠、盲肠、阑尾、结肠和直肠肛管病变的出血，根据临床表现可分为急性大出血、显性出血和隐性出血，但由于出血原因复杂，有些部位用常规检查手段难以到达，因此如何早期判断出血部位及性质往往比判断病因更为重要和实际。     

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。     

小肠平滑肌肿瘤与下消化道出血：附33例报告

探讨出血型小肠平滑肌肿瘤的临床特点及其诊断。方法回顾性病例分析。结果出血型小肠平滑肌肿瘤具有下列临床表现（１）反复间隙性消化道出血。（２）大多数病人的年龄在４０岁以下。（３）位于空肠部位的肿瘤约为回肠的３倍。     

Laparoscopic drainage of an intramural duodenal haematoma: a novel technique and review of the literature

Small bowel diverticulosis is an uncommon and often asymptomatic condition that is sporadically observed during radiographic examination or laparotomy. Although it is frequently seen in duodenum, jejunal and ileal locations are very rare. The majority of patients with jejunal diverticula have no symptoms. However, they can present with a number of acute and emergent complications with a high rate of mortality. Bleeding from jejunal diverticula occurs in less than 3% - 8% of patients and often present as fresh rectal haemorrhage. This can confuse the clinician since a bleeding source in colon is far more common. We report a patient with acute massive rectal bleeding. Abdominal CT angiography demonstrated a jejunal diverticulum as the bleeding source and the patient underwent resection of the affected segment. She has since remained free of gastrointestinal bleeding. Although jejunal diverticulosis is rare, it is an important differential diagnosis for patients with gastrointestinal haemorrhage of unknown origin as it may cause extensive rectal bleeding. Abdominal CT angiography can localize the bleeding source and resection of the affected bowel and primary anastomosis is the treatment of choice.     

下消化道出血60例诊断分析

目的探讨少见原因引起下消化道出血的诊断方法。方法对近20年内经手术明确诊断的60例下消化道出血病人术前的诊断方法进行回顾性分析。结果小肠钡餐检查的阳性检出率为16.9%(10/59),气钡双重造影的阳性率为20.0%(3/15),选择性肠系膜动脉造影阳性检出率为79.5%(35/44),CT的阳性率为26.3%(5/19),核素扫描的诊断符合率为58.3%(21/36)。78.3%(47/60)病变位于空、回肠,21.7%(13/60)位于结、直肠。血管畸形占33.3%(20/60),小肠间质瘤占30.0%(18/60)。结论合理掌握各种诊断手段的适应证和时机可望早期诊断下消化道出血。经动脉导管放置钢丝标记出血部位有益术中找出病灶所在肠段。     

Clinical features and treatment of lower intestinal hemorrhage

We have experienced 471 patients with anal bleeding during the past seven years. The Results are as follows: 1. As for the types of disease, incidence of hemorrhoid, colorectal cancer and ulcerative colitis (UC) was high, while that of small intestinal problems was low. 2. In the cases of remarkable bleeding from the lower intestinal tract, massive or acute progressive bleeding was less frequent than expected. 3. Inflammatory diseases were the main causes of massive bleeding. Bleeding by UC was the major indication for urgent operation. In the cases with acute massive hemorrhage, basic complications were often found and the possibility of the diseases of small intestine and blood vessel disorders also should be considered. 4. At the examination of bleeding patients, it is efficient to explore the lower colon and rectum first by colonoscopy or sigmoidoscopy, for most of the bleeding lesions are found in these portions. 5. As for surgical treatment, most of colorectal cancer patients with hemorrhage are able to be operated with wait- and -see management. For UC patients, complete cure operation is possible even if they have high-dose steroid medication.     

选择性腹腔动脉造影及介入栓塞在下消化道出血中的应用价值

探讨急性下消化道大出血的诊断和治疗方法。方法１９９５年１０月以来采用选择性腹腔动脉造影及介入栓塞来诊断及治疗急性下消化道大出血１３例。结果１３例病人经１４次选择性腹腔动脉造影,１２例发现出血动脉,阳性率９２％。     

Right-sided colonic diverticular disease as a source of lower gastrointestinal bleeding

Right-sided colonic diverticular disease is a distinct disease entity uncommon in the West. Occasionally, the condition may be complicated by hemorrhage and present as lower gastrointestinal bleeding. We report a series of 25 cases of bleeding right colon diverticulosis and discuss its presentation and management. Patients were selected from the colonoscopic reports of all 190 patients presented with suspected acute lower gastrointestinal bleeding in National University Hospital, Singapore, from 1988 to 1994. Fifty-seven patients (30%) had bleeding diverticulosis in which 25 patients (44%) suffered from right-sided disease. Sixty-four per cent of patients had a history of hypertension. Patients presented with either fresh blood in stools or melena. Fifteen patients (60%) required blood transfusion (median, 2 units). Colonoscopy showed blood clots in the right colon in 15 cases (60%) and active bleeding from the right colon diverticula in 3 patients (12%). The bleeding stopped spontaneously in 16 patients (64%). The other 9 patients required surgery because of continuous or recurrent bleeding. All had a right hemicolectomy performed. The hospital stay was 13 days in this group, compared with 5 days for those undergoing conservative treatment (P = 0.0004). There were no deaths. No patients had further bleeding episodes during a median 7-month follow-up.     

重症急性胰腺炎合并出血的影像诊断与介入治疗

目的 探讨影像诊断及介入治疗在重症急性胰腺炎患者并发出血时的应用价值。方法 回顾性分析本单位1999年3月至2005年9月间收治的32例重症急性胰腺炎并发出血患者的影像诊断及介入治疗的临床资料。结果 32例患者中以消化道出血为主者8例，以腹腔出血为主者21例，以假性囊肿内出血为主者3例。26例患者通过血管造影证实为假性动脉瘤破裂出血，其中23例行超选择性栓塞以控制出血，8例行多次栓塞治疗，3例栓塞失败后给予垂体后叶素灌注控制出血。另有3例患者经磁共振血管造影检查证实为胰源性门脉高压导致的静脉破裂出血，其中1例通过介入断流和放置支架控制出血。3例患者未找到出血血管，行手术治疗。32例患者中治愈2l例，死亡11例，无1例发生血栓形成及脏器缺血坏死等严重并发症。结论 重症急性胰腺炎并发出血时应尽早行血管造影，同时结合增强CT、磁共振血管造影及消化道内镜迅速明确出血部位及原因，介入治疗可作为控制出血的首选治疗措施，必要时行手术治疗。     

消化道平滑肌肿瘤的诊断与治疗（附175例报告）

目的 探讨消化道平滑肌肿瘤（ＳＭＴ）的临床病理特点和外科处理问题,方法 收集和分析１７５例消化道ＳＭＴ的临床病理资料,结果 平滑肌瘤６８例,上皮样平滑肌瘤３例,平滑肌肉瘤１０４例;位于食管１６例,胃７９例,小肠４２例,直肠１８例十二指肠和结肠均为１０例。主要临床表现为腹痛,消化道出血及腹部包块。内镜和Ｘ线钡剂检查联合应用的术前阳性诊断率达８６．６％,手术切除率为９２．６％,结论 消化道ＳＭＴ好发于     

克罗恩病并发症的手术治疗

目的总结克罗恩病并发症的临床特点及外科治疗方法。方法对2010年1月~2012年7月北京协和医院外科手术治疗的36例合并并发症的克罗恩病患者临床资料进行回顾性分析。结果本组36例克罗恩病患者并发症包括肠梗阻27例,肠瘘6例,急性肠穿孔4例,消化道出血5例。手术方式:小肠部分切除吻合术12例,腹腔镜右半结肠切除+回结肠吻合术11例,右半结肠切除+回肠造口术2例,回盲部切除、回结肠吻合术3例,小肠部分切除+结肠部分切除肠吻合术6例,回结肠吻合口切除重建术1例,以及其他1例。11例患者出现术后并发症,包括切口感染5例,腹腔感染2例,消化道出血3例,下肢深静脉血栓、肺栓塞1例。其中2例死亡。结论克罗恩病并发症以肠梗阻及肠瘘多见,手术是目前克罗恩病治疗的重要手段。     

Diagnostic and therapeutic approaches to bleeding from lower parts of the digestive system

Bleeding from the gastrointestinal tract represents relatively common diagnostic and therapeutic challenge in clinical work of gastroenterologists and surgeons. Bleeding from the lower GI (LGIB) is mostly caused by pathologic conditions of the colon, although the source of bleeding cannot always be exactly localized, thus rendering optimal and prompt therapy difficult. During two year period, at IlI department of the First Surgical Clinic in Belgrade, we performed 424 colonoscopies for LGIB. According to our results the exact diagnosis was established in about 76% (324 patients) showing a great similarity with the results of other published studies (varying between 74% and 89%). The most common causes of bleeding were diverticulosis (37.11%), polyposis (10.3%) and colorectal cancer (46.14%). Besides that we have mentioned some specific facts involving the diagnosis and treatment of LGIB with an accent on some rare conditions, like angiodysplasia. Review of the diagnostic procedures and treatment modalities of the LGIB is useful for everyone who meets with this type of pathology in clinical practice. The diagnostic approach and the surgical treatment of these patients may represent a great problem, since the planning of the operative procedure can be very difficult and with uncertain result. Based on the literary data and our experience we have tried to set the algorithm of the diagnostics and treatment of the LGIB.