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目的 探讨大肠镜在不明原因和部位的急性小肠大出血手术中的应用方法和临床疗效。方法 对1995～2003年28例不明原因的急性小肠大出血病人，剖腹探查后行全小肠大肠镜检查，结合快速病理检查和外科处理，明确出血原因和部位，给予相应治疗。结果 全组28例病人均明确了出血原因和部位，十二指肠降部以下至Treitz韧带出血11例，空回肠出血17例；病理检查小肠恶性肿瘤出血7例(25．0％)，小肠良性肿瘤出血5例(18．2％)，小肠其他良性疾病16例(56．8％)。小肠壁部分切除术4例，部分小肠切除吻合术17例，根治性小肠切除吻合术7例。无手术死亡。结论 术中大肠镜检查对不明原因小肠出血诊断方便、及时、确切，可用于术前检查，如不能明确病因的小肠出血、急性大出血危及生命、急诊检查条件差时，尤其适用于不允许进行较长时间、较复杂检查的小肠出血病人。

Application of enteroscopy to the operation of acute small intestinal bleeding

Objective To investigate the application and clinical effects of intraoperative enteroscopy in patients with obscure acute small intestinal bleeding. Methods Laparotomy and intraoperative enteroscopy were performed in 28 patients with obscure acute small intestinal bleeding from 1995 to 2003. Results The bleeding cause and site of all the cases were ascertained.Bleeding eleven cases was from under descending portion of duodenum to Treitz ligament. Bleeding in jejunum and ileum existed in 17 cases.The small intestine of all the cases was performed pathological examination. Among them,7 cases (25.0%),5 cases (18.2%) and 16 cases (56.8%) of bleeding were because of malignant tumor,benign tumor and other benign diseases respectively. Among all the cases, 4 cases,17 cases and 7 cases were performed local small intestine wall resection,segment small intestine resection and anastomosis,and radical small intestine resection. No cases died in the operation. Conclusion Intraoperative enteroscopy is a valuable tool for exploring obscure accute small intestinal bleeding.It is simple,timely and accurate,and can be used in preoperative examination,such as obscure small intestinal bleeding,acute massive bleeding and bad emergency examination.Those with lethal massive bleeding who are not permitted any delay should undergo laparotomy intraoperative enteroscopy.