血管异常致下消化道出血的诊疗体会

目的提高对血管异常所致下消化道出血的诊断与治疗水平。方法分析血管异常所致下消化道出血22例的资料。结果临床表现以血便、黑便为主,12例入院时伴有贫血。经钡餐、电子内镜、血管造影多项检查,确诊为血管异常所致的下消化道出血。肠镜检出9例,肠系膜动脉造影检出13例。病理及手术证实血管发育不良13例,动静脉畸形6例,门脉高压相关肠血管病变3例。血管病变与出血灶位于小肠占72.7%（16/22）、右半结肠占18.2%（4/22）,合并回肠结肠病变占9%（2/22）。3例内科治疗血止,19例经手术治疗,出血得到有效控制。结论下消化道活动性出血,早期肠镜检查与选择性血管造影有助于明确出血部位及诊断。手术切除病变肠段对控制出血有效,复发再出血率低。

Diagnosis and treaatment of lower gastrointestinal bleeding caused by vascular anomalies

Objective To improve the level of diagnosis and treatment of lower gastrointestinal bleeding by vascular anomalies.Methods To analyze the 22 cases data of lower gastrointestinal bleeding by vascular anomalies.Results Hematochezia and melena were the most common clinical resentations,hypotension found in twelve patients at admission.By the barium studies,colonoscopic and angiographic examinations being performed to detect the bleeding sources.Bleeding site was identified by colonoscopy in 9 cases,by angiography in 13 cases.The pathology and surgery showed bleeding due to angiodysplasia in 13 cases,arteriovenous malformation in 4 cases,from portal hypertensive enteropathy and small bowel varices in 3 cases.The hemorrhage from the small intestine was 72.7% （16/22）,the right hemicolon was 18.2%（4/22）,and combined ileum colon lesions was 9% （2/22）.The 3 cases bleeding was effective controled by medical treatment,and the 19 cases by surgical treatment.Conclusion With early Colonoscopy and selective angiography at bleeding episode the identification rate of source of lower gastrointestinal bleeding would increase.Surgical treatment of the involved bowel segment was effective to control lower gastrointestinal bleeding and prevent recurrence.