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。

THE ENDOSCOPIC DIAGNOSIS VALUE OF LAPAROTOMY ON 21 PATIENTS WITH GASTROINTESTINAL BLEEDING

[Objective]To discuss the value and safety of laparotomy in the diagnosis of gastrointestinal bleeding endoscopic.[Methods]Retrospectively analyzed the clinical data of 21 cases with gastrointestinal bleeding required emergency laparotomy for intraoperative endoscopy,evaluated its value.[Results]The causes of bleeding and the site of 21 patients were clear by intraoperative endoscopy.The positive detection rate was 100%,of which 8 cases diagnosed as peptic ulcer,accounted for 38.1%.2 cases were descending p...