术中纤维肠镜对急性小肠大出血诊疗价值

目的探讨纤维结肠镜在不明原因急性小肠大出血手术中的应用价值。方法对我院2002年2009年37例不明原因的急性小肠大出血病人，剖腹探查后行全小肠纤维结肠镜检查．在明确出血原因和部位，结合快速病理检查，给予相应外科治疗。结果全组37例病人均明确了出血原因和部位，其中十二指肠降部以下至Treitz韧带出血13例，空回肠出血24例；病理检查小肠恶性肿瘤出血12例（32．4％），小肠良性肿瘤出血8例（21．6％），小肠其他良性疾病17例（45．9％）。小肠壁部分切除术13例．部分小肠切除吻合术13例，根治性小肠切除吻合术11例。全组术后无伤口感染，腹腔内感染和肠瘘等并发症；围手术期病例亦无发生。术后34例获得随访，随访时间为2年，未发现复发出血，有3例小肠恶性肿瘤复发死亡。全组术后无伤口感染，腹腔内感染和肠瘘等并发症；亦无围手术期病例发生。术后34例获得随访，随访时间为2年，未发现复发出血，有3例小肠恶性肿瘤复发死亡。无手术死亡。结论术中纤维结肠镜检查对原因不明的小肠急性大出血具有及时明确出血原因和部位。它在提供治疗方法的选择有重要的价值；特别适用于小肠大出血病情危重者和急诊检查条件差的医院。

The values of diagnosis and treatment of intraoperative fibercolonoscopy for acute massive bleeding of small intestine

Objective To investigate the applied value of intraoperative fibrecolonoscopy in the use of acute small intestinal massive bleeding of unknown cause. Methods From March 2002 to May 2009, 37 cases with acute small intestinal massive bleeding of unknown cause underwent laparotomy and fibercolonoscopy in total small intestinal combined with rapid pathological examination. In the cause and site of bleeding were confirmed ,the surgical treatment was performed. Results The cause and site of bleeding were confirmed in 37 cases. Among them, the bleeding of descending part of duodenum to Treitz ligament was in 13 cases, the bleeding of jejuno-ileum was in 24 cases. Pathological examination： The bleeding from small intestinal malignant tumor,small intestinal benign,and small intestinal other benign diseases were in 12 cases（32.4%）,8 cases（21.6%） and 17 cases（45.9%） respectively.The small intestinal wall partial resection, partial enterectomy and radical small intestinal resection and anastomosis were in 13,13 and 11 cases respectively. No wound infection, abdominal cavity infection and intestinal fidtula were found in all cases after operation. Postoperative follow-up was got in 34 cases. Follow-up time was 2 years. No recurrent bleeding was found during follow-up period. Three cases with small intestinal malignant tumor died from recurrence. Conclusion Intraoperative fibercolonoscopy possesses in time confirmed cause and site of bleeding for acute small intestinal massive bleeding of unknown cause. It has an important value in providing selection of therapeutic methods. It＇s suitable to critical stage of acute intestinal massive bleeding and a hospital of poor condition of emergency examination.