剖腹探查术中内镜诊断消化道大出血21例的价值

[目的]探讨剖腹探查术中内镜诊断消化道大出血的价值和安全性。[方法]回顾性分析了21例消化道大出血须急诊剖腹探查的患者进行术中内镜检查的临床资料,评价其价值。[结果]21例患者通过术中内镜检查明确了原因及出血部位。阳性检出率是100%。其中诊断为消化性溃疡8例,占38.1%。十二指肠降部单发腺瘤2例,占9.5%;十二指肠淋巴瘤3例,占14.3%;贲门撕裂症3例,占14.3%;回肠淋巴瘤4例,占19.1%;胃空肠吻合口出血1例,4.8%。术前选择性血管造影术15例,仅有3例提示了出血可能所在的部位,选择性血管造影术的检出率为20%。明显低于术中应用内镜的检出率(P﹤0.05)。检查用时平均16min,术中内镜检查患者全部明确出血部位及原因,然后对症手术治疗,在手术后没有患者出再出血。[结论]急性消化道大出血不明原因时行剖腹探查术,术中内镜能够明确出血部位而采取相应措施,能准确定位与定性,可提高剖腹探查的成功率。     

术中内镜诊断小肠出血的临床应用

目的　探讨术中内镜在小肠出血诊断中的运用价值。方法　对于经内科综合治疗不止血 ,而常规检查不能明确病因的消化道出血患者 ,转外科行剖腹探查 ,并在术中进行内镜检查 ,寻找出血原因和部位。结果　 19例患者中有 17例成功地检出了出血部位和原因。结论　术中内镜检查对于小肠出血是一种操作较简便、出血检出率高的方法。     

结肠镜在小肠大出血手术中的应用体会

目的 探讨结肠镜在不明原因小肠大出血手术中的应用价值。方法 对17例不明原因的小肠大出血患者，术中行全小肠结肠镜检查，结合快速冰冻切片，明确出血部位和原因，给予相应外科处理。结果 全组17例患者均明确了出血原因和部位，十二指肠球部以下至屈氏韧带出血5例，空回肠出血12例；病理检查小肠恶性肿瘤4例，小肠良性疾病13例；行小肠壁部分切除术2例，部分小肠切除吻合术11例，根治性小肠切除吻合术4例。全组无手术死亡病例，随访1年无术后复发出血。结论 术中结肠镜检查对不明原因小肠出血诊断快捷、确切，尤其适用于不允许进行较长时间、较复杂检查的小肠出血患者。     

结肠镜在小肠大出血手术中的应用体会

目的 探讨结肠镜在不明原因小肠大出血手术中的应用价值.方法 对17例不明原因的小肠大出血患者,术中行全小肠结肠镜检查,结合快速冰冻切片,明确出血部位和原因,给予相应外科处理.结果 全组17例患者均明确了出血原因和部位,十二指肠球部以下至屈氏韧带出血5例,空回肠出血12例;病理检查小肠恶性肿瘤4例,小肠良性疾病13例;行小肠壁部分切除术2例,部分小肠切除吻合术11例,根治性小肠切除吻合术4例.全组无手术死亡病例,随访1年无术后复发出血.结论 术中结肠镜检查对不明原因小肠出血诊断快捷、确切,尤其适用于不允许进行较长时间、较复杂检查的小肠出血患者.     

急性消化道大出血的介入治疗

急性消化道大出血的患者短时间出现休克表现,受胃肠道内过量出血和胃内容物的影响,内镜难以作出明确判断,急诊剖腹探查难以确定出血部位的情况下有较大的盲目性,临床处理不及时,将危及生命。现将我院介入治疗急性消化道大出血12例报告如下。     

胶囊内镜的临床应用与评价

目的评价胶囊内镜对小肠疾病及其对食管、胃、结肠病变的诊断价值。方法对5例健康体检者，39例疑患小肠疾病的患者进行胶囊内镜检查。结果44例患者进行了45次胶囊内镜检查，1例因胶囊内镜滞留在胃内而进行第二次检查，检查过程中患者无任何不适。胶囊内镜顺利通过回盲辩41例，2例胶囊行至回肠末端，1例胶囊滞留于胃内。全部胶囊在检查结束后．排出体外。检出了15种病变：食道静脉曲张、糜烂性胃炎、胆汁返流性胃炎、胃黄色瘤、十二指肠炎、十二指肠溃疡、小肠肿瘤、小肠血管畸形、克罗恩病、小肠单发及多发息肉、非特异性小肠炎、吸收不良综合征、小肠憩室、结肠黑病变、结肠癌。结论胶囊内镜检查操作简单、安全、有效。对消化道疾病尤其是小肠疾病有较高的诊断价值。     

十二指肠憩室合并上消化道大出血12例临床报道

目的 探讨十二指肠憩室合并上消化道大出血的诊治方法。方法 对12例十二指肠憩室合并上消化道大出血病人进行分析。结果 12例均为术后确诊，十二指肠横部憩室伴上消化道大出血5例，降部憩室伴出血7例，其中1例为第2次手术才确诊，有2例合并十二指肠球部溃疡，均治愈出院。结论 十二指肠憩室术前确诊较困难，术中探查尤为重要，探查时要特别注意出血是憩室引起还是伴发病所致。不同部位十二指肠憩室合并上消化道大出血，有不同的治疗方案。     

消化道平滑肌肿瘤并发大出血

消化道平滑肌肿瘤临床少见,其发病率国外占住院病人0.01%,国内为0.019%,而整个消化道肿瘤中,平滑肌肿瘤只占2%。由于其发病率低,症状不典型,临床易发生误诊,尤其合并急性消化道大出血时,更是如此。本文共搜集四所医院消化道平滑肌瘤23例,其中食管平滑肌瘤2例,胃平滑肌瘤3例,肉瘤2例,十二指肠平滑肌瘤5例,肉瘤1例,空肠平滑肌瘤3例,肉瘤4例,直肠平滑肌瘤1例,肉瘤1例。23例中,并发大出血者14例,本文对此14例进行重点分析。一般资科14例中4例病变在胃,6例在十二指肠,4例在空肠。其中平滑肌瘤8例,平滑肌肉瘤6例。14例中,术前只有1例十二指肠平滑肌瘤确诊。胃平滑肌瘤皆误为胃癌,十二指肠平滑肌瘤中1例内镜误为广基息肉,3例诊为消化道出血;1例十二     

成人回肠重复畸形的诊断和治疗

目的结合临床病例探讨成人回肠重复畸形的临床诊断和治疗。方法收集1996～2004年我院住院的4例回肠重复畸形患者，其中3例以消化道出血、1例以腹部包块为主要症状。4例均行结肠镜检查未发现明确病灶。3例出血患者均行胃镜检查，2例行小肠镜检查，1例行电子胶囊内镜检查，除怀疑血管畸形外，未发现明确异常。4例患者均行剖腹探查手术，手术标本送病理检查。结果术中发现回肠距回盲部11～70cm处有长度分别为7～20cm的重复回肠肠管，有独立的肠系膜和血供，1例并发异位胰腺，1例伴回盲部炎性包块。病理结果提示4例均为回肠重复畸形，1例有胃黏膜异位。结论回肠重复畸形多在婴幼儿期被发现，成人极为少见，临床上可表现为腹痛、包块、消化道出血等，通过辅助检查一般较难在术前作出明确诊断。手术探查时能发现重复的肠管，手术医师需对该病有充分的了解和认识，才能避免误诊误治。     

胶囊内镜对小肠疾病的诊断价值

目的研究M2A胶囊内镜对胃肠道特别是小肠病变的检出率及病变类型,探讨胶囊内镜对小肠疾病的诊断价值.方法运用M2A胶囊内镜对37例疑诊小肠疾病和体检者进行检查.结果疑诊小肠疾病组发现小肠病变18处,包括克罗恩病、小肠寄生虫、回肠淋巴瘤、回肠Mechel憩室、小肠海绵状血管瘤、小肠息肉样病变、小肠糜烂、回肠末端炎、十二指肠炎或溃疡、十二指肠囊肿,病变检出率为81.8%,诊断阳性率为68.2%(15/22);高于体检组.两组病例M2A胶囊内镜在消化道不同部位的运行时间比较无显著差异,胶囊内镜平均工作时间,获取照片数量无显著差异,胶囊内镜图片质量佳,病人耐受性好.结论胶囊内镜对疑诊小肠疾病的病变检出率较高,而且安全无创,可以作为小肠疾病检查的首选方法.     

Small bowel stromal tumors diagnosed by capsule endoscopy

Small intestinal stromal tumors account for approximately 35% of all gastrointestinal stromal tumors. Gastrointestinal bleeding is considered as one of the main clinical symptoms for SISTs. Capsule endoscopy has brought revolution in small bowel diagnostics, as it is considered the best method of visualisation of the entire small intestine. Besides, it is well tolerated by patients and is accompanied by a low number of complications. It is also indicated as the first diagnostic method in gastrointestinal bleeding of obscure origin, following negative upper endoscopy and colonoscopy. CASE REPORT: 2 patients (a male and a female, aged 58 and 69, respectively) presented with obscure gastrointestinal bleeding have been examined by capsule endoscopy after negative upper endoscopy and colonoscopy. Videorecords have been assessed in both cases by two independent experts. The capsule reached the Bauchin-valve in both cases during the 8 hours of the testing time and the entire small bowel was clearly visible. - Based on the capsule endoscopic images, for one of the two cases a tumor has been reported as the background of the small intestinal bleeding. In the other case we could mark the location of the bleeding, while we were unable to ascertain the type of the actively bleeding lesion during the test. In order to determine the accurate bleeding source double-balloon enteroscopy was performed in the second case. After surgery the histological and immunohistochemical tests have justified the presence of spindle cell GISTs. Taking into consideration the Fletcher-classification, for the tumor size and the mitotic index, both cases can be classified as a GIST of low malignant potential. CONCLUSIONS: An early diagnosis and application of a definitive therapy become possible by using capsule endoscopy, therefore the chance of survival of the patients might be increased.     

胶囊内镜检查患者的人性化护理干预

目的探讨和评价胶囊内镜对胃肠道疾病的诊断价值及护理要点。方法 2009年1月至2011年2月间100例有消化道症状的患者应用胶囊内镜检查。结果 100例行胶囊内镜检查的患者,发现小肠黏膜血管渗血20例,小肠多发溃疡15例,小肠肿物13例,糜烂性胃炎10例,慢性胃炎23例,回肠多发息肉2例,贲门失驰缓2例,贲门占位、胃底占位2例,回肠末段及盲肠段淋巴滤泡增生3例,无异常10例。检查过程顺利,无明显并发症。结论胶囊内镜能对消化道疾病进行诊断,尤其对小肠病变的诊断、筛查更具优势,适当的护理配合是顺利完成胶囊内镜的重要条件。     

急诊胃镜对86例急性上消化道出血的诊疗分析

目的：评估急诊胃镜对上消化道出血的诊治价值。方法：选择86例急性上消化道出血患者,24h内行急诊胃镜检查,并给予相应治疗,分析病史资料。结果：86例急性上消化道出血患者治愈84例,死亡1例,再出血死亡1例,止血成功率97．67％。结论：急诊胃镜在急性上消化道出血的诊疗上及时、安全性好,值得广泛推广和应用。     

Evaluation of diagnostic yield and clinical impact of capsule endoscopy in patients with obscure gastrointestinal bleeding

BACKGROUND AND AIMS: The major indication of small bowel capsule endoscopy is the diagnostics of obscure gastrointestinal bleeding. The present retrospective study was aimed to analyze the diagnostic yield, positive and negative predictive values and clinical impact of capsule endoscopy in patients with obscure gastrointestinal bleeding. PATIENTS AND METHODS: During a 36 month period at two workplaces 66 capsule endoscopy studies were performed in 62 patients with gastrointestinal bleeding who had undergone non-diagnostic upper endoscopy and colonoscopy. Capsule video recordings were evaluated by two investigators at both workplaces. Capsule endoscopy findings were divided into 3 groups according to the bleeding source: definitive bleeding source (48 patients), uncertain bleeding potential (5 patients), and negative finding (8 patient). Patients after capsule endoscopy were followed-up until a mean of 20 (1-41) months. RESULTS: A definitive small bowel bleeding source was detected in 78.7% of the cases studied by capsule endoscopy. Definitive bleeding sources included angiodysplasia (28 cases), small bowel Crohn's disease (5 cases), small bowel tumor (5 cases), small bowel stenosis (2 cases), NSAID therapy related ulcer (1 case), non-specific inflammation (1 case) and helminthiasis (1 case) respectively. The positive and negative predictive values of capsule endoscopy studies were 95.8% and 84.6% respectively. In cases with definitive bleeding sources 72% of patients received therapy in accordance with capsule endoscopy findings (surgery in 18 patients, medical treatment modification in 16 patients, chemoembolisation in 1 patient). During the follow-up period 17.7% of the patients had rebleeding. CONCLUSIONS: Capsule endoscopy is a useful and effective diagnostic method in cases with obscure gastrointestinal bleeding. Effective therapy may be introduced in accordance with the majority of positive capsule endoscopy results.     

Duodenal varix rupture a rare cause of gastrointestinal bleeding from portal hypertension

The duodenal varix rupture is a rare and serious complication of portal hypertension. The authors report one case of duodenal varix rupture in a 38 year old woman, revealing portal hypertension, which caused a massive gastro-intestinal bleeding. The endoscopy didn't allow to conclude to a diagnosis. An emergent laparotomy was necessary regarding the massive bleeding. A duodenal varix suture ligation was performed after pyloroduodenotomy. She had a well recovery. After a review of literature, the authors conclude that this abnormal situation is rare, its diagnostic is difficult and it has several therapeutic strategies.     

胶囊内镜适应症的初步探讨

【目的】评价胶囊内镜对不同症状和消化道不同部位的临床诊断价值。【方法】于2010年8月-2011年8月期间,对53例患者进行了胶囊内镜检查。将受检者分为不明原因的消化道出血、疑为功能性胃肠病、腹痛腹泻腹胀、便秘、体检等共5组。【结果】1例因吞服胶囊后无图像信号,1例因个人原因吞咽胶囊失败,其余51例均顺利到达结肠,胶囊内镜小肠病变总的诊断率为92.15%(47/51);空肠及回肠阳性诊断率为52.94%【结论】胶囊内镜是一种非侵入性的检查手段,检查安全,顺应性好,诊断价值也较高。     

Identification of a Meckel's diverticulum bleeding by urgent capsule endoscopy

A 10 year-old patient was admitted to our hospital due to severe gastrointestinal bleeding. His symptoms included hematochezia and fainting. Neither emergency upper endoscopy nor colonoscopy had identified the site of bleeding. During the colonoscopy they noticed that fresh blood entered the cecum from the ileum. An urgent capsule endoscopy was performed 8 hours after the patient admission. They placed the capsule with specific endoscopic technique into the proximal duodenum under general anesthesia. During 3,5 hours by the small bowel passage the capsule moved to the ileum and a focal bleeding lesion was detected at this site, suggesting the typical picture of bleeding Meckel's diverticulum. The patient was transfused by 1 unit of blood, with a minimum haemoglobin level 95 g/l. By surgery the ulcerated Meckel's diverticulum was identified and resected. Histopathology showed ectopic gastric mucosa. Surgical resection of the diverticulum resulted complete healing of this patient. The capsule endoscopy diagnosis was prompt, precise, and the all examinations were carried out within 24 hours. Involving urgent small bowel capsule endoscopy into the diagnostic workup of the obscure bleeding patient could considerably shorten the time to achieve a correct diagnosis and allowed the early institution of definitive treatment. By this one could spare a great number of costly alternative investigations with low diagnostic yield.     

Acute mesenteric ischemia: Study of predictive factors of mortality

Background: Acute mesenteric ischemia is a surgical emergency that requires a quick diagnosis and therapeutic care. Without treatment, the outcome is towards intestinal infarction whose prognosis remains grim. Aim: To look for predictive factors of mortality of this disease. Methods: We retrospectively reviewed the clinical data of patients hospitalized between January 2000 and December 2008 for acute mesenteric ischemia. Univariate and multivariate analysis of factors that could influence mortality was conducted. Results: 26 patients, predominantly male, were included. The mean age was 60 years. These patients were cared for on average 4 days after the onset of symptoms. The diagnosis was made pre-operatively in 9 patients, by CT scan in 8 patients and by Doppler ultrasound in 1 patient. The cause of AMI was arterial thrombosis in 19 cases, venous thrombosis in 4 cases and non occlusive mesenteric ischemia in 3 cases. 25 patients were operated on emergency 24 times by a laparotomy and one time by a laparoscopy. The surgery consisted in bowel resection in 15 patients; an abstention was decided in one case of venous mesenteric ischemia and in 9 cases where necrosis affected all small bowels. Revascularization of the superior mesenteric artery was associated in 4 cases. Outcome was simple in 8 patients. The mortality rate was 69%, death occurred in a period of J0 to J90 after surgery. This rate wasn't influenced by age or sex. It was higher in patients with preoperative collapse (p = 0.02) and having an expansive bowel necrosis (p=.0001). The prognosis is better in cases of venous infarction with a mortality rate of zero. Conclusion: Prognosis of acute mesenteric ischemia depends on the aetiology and the quickness of treatment. It is directly linked to the extension of intestinal infarction. An urgent and multidisciplinary care is necessary.