胃肠道血管畸形致消化道出血诊治体会

目的 总结血管畸形所致消化道出血的诊断及治疗经验。方法 回顾性分析我院1989-1999年间26例胃肠道血管畸形所致消化道出血的临床资料。结果 内镜血管畸形的检出率为42%，ECT消化道出血的检出率为55%，选择性动脉造影血管畸形的检出率为83%，剖腹探查血管畸形的检出率为100%，保守治疗1例，病变肠段手术切除14例，介入治疗4例，其余行扩张血管缝扎，胃十二指肠结扎术或硬化剂局部注射，效果良好，结论 怀疑血管畸形致胃肠道出血时，首选内镜检查，进一步检查可行ECT，选择性动脉造影是诊断血管畸形最有效的方法，必要时剖腹探查并可结合术中肠镜确诊，治疗以手术切除病灶最有效，辅以血管缝扎及介入治疗。

Experience in diagnosis and treatment of digestive tract bleeding with gastrointestinal vascular malformation

Objective To summarize the experience of diagnosis and management of bleeding with GIVM.Method The clinical data of 26 patients admitted from 1989 to 1999 were analyzed retrospectively.Results GIVM with bleeding were revealed by endoscopies (42%),by ECT (55%),by selective arteriography (83%),by barium radiography (0%),and by exploratory laparotomy(100%).1 case was cured by conservative treatment.Bleeding intestinal segment was resected in 14 cases.4 cases were cured by interventional therapy.The others were cured by sclerosing agent injection,or by suture ligation of the dilated vessel or arterial gastroduodenalis.Conclusions Endoscopy is the first choice in the bleeding from GIVM.ECT may beused later if endoscopy is useless.Selective arteriography is the most valuable method in GIVM diagnosis.If necessary, exploratory laparotomy and intraoperative endoscopies may be used.Resecting bleeding segment is the most effective treatment.Other methods such as interventional therapy and suture ligation of dilated vessel are also effective.